Physician Compare National (NPI:1639192412)

HEALTHCARE PROVIDER: MARK RANDALL BOWMAN M.D.

Physician Compare National contains general information about individual eligible professionals (EPs) such as demographic information and Medicare quality program participation.

Individual Professional Information
NPI	1639192412
	Unique healthcare provider (clinician) ID assigned by NPPES
PECOS UID	8729307244
	Unique individual clinician ID assigned by PECOS
Professional Enrollment ID	I20181221001286
	Unique ID for the individual professional enrollment that is the source for the data in the observation
Provider Last Name	BOWMAN
	Individual professional last name
Provider First Name	MARK
	Individual professional first name
Provider Middle Name	RANDALL
	Individual professional middle name
Provider Gender	M
	The provider's gender if the provider is a person.

Medical School Information
Medical School Name	NORTHEASTERN OHIO UNIVERSITY COLLEGE OF MEDICINE
	Individual professional's medical school
Graduation Year	1991
	Individual professional's medical school graduation year
Primary Specialty	GENERAL PRACTICE
	Primary medical specialty reported by the individual professional in the selected enrollment

Practice Information
Line 1 Street Address	15 82ND DR
	Group Practice or individual's line 1 address
Line 2 Street Address	SUITE 100
	Group Practice or individual's line 2 address
City	GLADSTONE
	Group Practice or individual's city
State	OR
	Group Practice or individual's state
Zip Code	970272550
	Group Practice or individual's zip code (9 digits when available)

Hospital(s) Affiliation Information
Hospital Affiliation CCN 1	381317
	Medicare CCN of hospital where individual professional provides service 1
Hospital Affiliation LBN 1	TILLAMOOK REGIONAL MEDICAL CENTER
	Legal business name of hospital where individual professional provides service 1
Professional Accepts Medicare Assignment	Y