Physician Compare National (NPI:1639233687)

HEALTHCARE PROVIDER:

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

Individual Professional Information
NPI	1639233687
	Unique healthcare provider (clinician) ID assigned by NPPES
PECOS UID	0547397150
	Unique individual clinician ID assigned by PECOS
Professional Enrollment ID	I20100429000623
	Unique ID for the individual professional enrollment that is the source for the data in the observation
Provider Last Name	NELSON
	Individual professional last name
Provider First Name	ROBERT
	Individual professional first name
Provider Middle Name	N
	Individual professional middle name
Provider Gender	M
	The provider's gender if the provider is a person.

Medical School Information
Medical School Name	GEORGE WASHINGTON UNIVERSITY SCHOOL OF MEDICINE
	Individual professional's medical school
Graduation Year	1956
	Individual professional's medical school graduation year
Primary Specialty	OBSTETRICS/GYNECOLOGY
	Primary medical specialty reported by the individual professional in the selected enrollment

Practice Information
Line 1 Street Address	3120 WEBSTER ST
	Group Practice or individual's line 1 address
Line 2 Street Address	SUITE 1
	Group Practice or individual's line 2 address
City	OAKLAND
	Group Practice or individual's city
State	CA
	Group Practice or individual's state
Zip Code	946093421
	Group Practice or individual's zip code (9 digits when available)

Hospital(s) Affiliation Information
Hospital Affiliation CCN 1	050043
	Medicare CCN of hospital where individual professional provides service 1
Hospital Affiliation LBN 1	ALTA BATES SUMMIT MEDICAL CENTER
	Legal business name of hospital where individual professional provides service 1
Hospital Affiliation CCN 2	050305
	Medicare CCN of hospital where individual professional provides service 2
Hospital Affiliation LBN 2	ALTA BATES SUMMIT MEDICAL CENTER - ALTA BATES CAMP
	Legal business name of hospital where individual professional provides service 2
Professional Accepts Medicare Assignment	Y