Physician Compare National (NPI:1649334236)

HEALTHCARE PROVIDER: DONALD GEORGE DICKEN MD

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

Individual Professional Information
NPI	1649334236
	Unique healthcare provider (clinician) ID assigned by NPPES
PECOS UID	2466627971
	Unique individual clinician ID assigned by PECOS
Professional Enrollment ID	I20111214000057
	Unique ID for the individual professional enrollment that is the source for the data in the observation
Provider Last Name	DICKEN
	Individual professional last name
Provider First Name	DONALD
	Individual professional first name
Provider Middle Name	G
	Individual professional middle name
Provider Gender	M
	The provider's gender if the provider is a person.

Medical School Information
Medical School Name	UNIVERSITY OF MINNESOTA MEDICAL SCHOOL
	Individual professional's medical school
Graduation Year	1987
	Individual professional's medical school graduation year
Primary Specialty	PHYSICAL MEDICINE AND REHABILITATION
	Primary medical specialty reported by the individual professional in the selected enrollment

Practice Information
Line 1 Street Address	1200 N 14TH AVE
	Group Practice or individual's line 1 address
Line 2 Street Address	SUITE 275
	Group Practice or individual's line 2 address
City	PASCO
	Group Practice or individual's city
State	WA
	Group Practice or individual's state
Zip Code	993014079
	Group Practice or individual's zip code (9 digits when available)

Hospital(s) Affiliation Information
Hospital Affiliation CCN 1	501337
	Medicare CCN of hospital where individual professional provides service 1
Hospital Affiliation LBN 1	LOURDES MEDICAL CENTER
	Legal business name of hospital where individual professional provides service 1
Hospital Affiliation CCN 2	500058
	Medicare CCN of hospital where individual professional provides service 2
Hospital Affiliation LBN 2	KADLEC REGIONAL MEDICAL CENTER
	Legal business name of hospital where individual professional provides service 2
Hospital Affiliation CCN 3	500053
	Medicare CCN of hospital where individual professional provides service 3
Hospital Affiliation LBN 3	TRIOS HEALTH
	Legal business name of hospital where individual professional provides service 3
Hospital Affiliation CCN 4	500054
	Medicare CCN of hospital where individual professional provides service 4
Hospital Affiliation LBN 4	PROVIDENCE SACRED HEART MEDICAL CENTER
	Legal business name of hospital where individual professional provides service 4
Professional Accepts Medicare Assignment	Y