Physician Compare National (NPI:1639284540)

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	1639284540
	Unique healthcare provider (clinician) ID assigned by NPPES
PECOS UID	2860522935
	Unique individual clinician ID assigned by PECOS
Professional Enrollment ID	I20100616000566
	Unique ID for the individual professional enrollment that is the source for the data in the observation
Provider Last Name	JOHNSON REED
	Individual professional last name
Provider First Name	SONNORA
	Individual professional first name
Provider Gender	F
	The provider's gender if the provider is a person.

Medical School Information
Medical School Name	MICHIGAN STATE UNIVERSITY COLLEGE OF OSTEOPATHIC MEDICINE
	Individual professional's medical school
Graduation Year	1977
	Individual professional's medical school graduation year
Primary Specialty	INTERNAL MEDICINE
	Primary medical specialty reported by the individual professional in the selected enrollment

Practice Information
Organization Legal Name	INPATIENT CONSULTANTS OF MICHIGAN PC
	Legal name of the Group Practice that the individual professional works with- will be blank if the address is not linked to a Group Practice
Group Practice PAC ID	6709891286
	Unique Group Practice ID assigned by PECOS to the Group Practice that the individual professional works with- will be blank if the address is not linked to a Group Practice
Number of Group Practice members	61
	Total number of individual professionals affiliated with the Group Practice based on Group Practice PAC ID
Line 1 Street Address	1014 E GRAND RIVER AVE
	Group Practice or individual's line 1 address
Line 2 Street Address	CARETEL INNS OF BRIGHTON MI
	Group Practice or individual's line 2 address
City	BRIGHTON
	Group Practice or individual's city
State	MI
	Group Practice or individual's state
Zip Code	481161804
	Group Practice or individual's zip code (9 digits when available)
Phone Number	8102205222
	Phone number is listed only when there is a single phone number available for the practice location address

Hospital(s) Affiliation Information
Hospital Affiliation CCN 1	230151
	Medicare CCN of hospital where individual professional provides service 1
Hospital Affiliation LBN 1	BEAUMONT HOSPITAL - FARMINGTON HILLS
	Legal business name of hospital where individual professional provides service 1
Hospital Affiliation CCN 2	230002
	Medicare CCN of hospital where individual professional provides service 2
Hospital Affiliation LBN 2	ST MARY MERCY HOSPITAL
	Legal business name of hospital where individual professional provides service 2
Professional Accepts Medicare Assignment	Y