Physician Compare National (NPI:1659391084)

HEALTHCARE PROVIDER: JONATHON LEE FALLIS DPM

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

Individual Professional Information
NPI	1659391084
	Unique healthcare provider (clinician) ID assigned by NPPES
PECOS UID	1355398884
	Unique individual clinician ID assigned by PECOS
Professional Enrollment ID	I20050708000463
	Unique ID for the individual professional enrollment that is the source for the data in the observation
Provider Last Name	FALLIS
	Individual professional last name
Provider First Name	JONATHON
	Individual professional first name
Provider Middle Name	L
	Individual professional middle name
Provider Gender	M
	The provider's gender if the provider is a person.
Provider Credential Text	DPM
	The abbreviations for professional degrees or credentials used or held by the provider, if the provider is an individual. Examples are MD, DDS, CSW, CNA, AA, NP, RNA, or PSY. These credential designations will not be verified by NPS.

Medical School Information
Medical School Name	COLLEGE OF PODIATRIC MED AND SURGERY, DES MOINES UNIVERSITY
	Individual professional's medical school
Graduation Year	1996
	Individual professional's medical school graduation year
Primary Specialty	PODIATRY
	Primary medical specialty reported by the individual professional in the selected enrollment

Practice Information
Line 1 Street Address	1513 UNION AVE
	Group Practice or individual's line 1 address
Line 2 Street Address	SUITE 1400
	Group Practice or individual's line 2 address
City	MOBERLY
	Group Practice or individual's city
State	MO
	Group Practice or individual's state
Zip Code	652709403
	Group Practice or individual's zip code (9 digits when available)

Hospital(s) Affiliation Information
Hospital Affiliation CCN 1	260142
	Medicare CCN of hospital where individual professional provides service 1
Hospital Affiliation LBN 1	FITZGIBBON MEMORIAL HOSPITAL
	Legal business name of hospital where individual professional provides service 1
Hospital Affiliation CCN 2	260074
	Medicare CCN of hospital where individual professional provides service 2
Hospital Affiliation LBN 2	MOBERLY REGIONAL MEDICAL CENTER
	Legal business name of hospital where individual professional provides service 2
Professional Accepts Medicare Assignment	Y