Physician Compare National (NPI:1659522712)

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	1659522712
	Unique healthcare provider (clinician) ID assigned by NPPES
PECOS UID	8628137171
	Unique individual clinician ID assigned by PECOS
Professional Enrollment ID	I20081112000682
	Unique ID for the individual professional enrollment that is the source for the data in the observation
Provider Last Name	DAVIS
	Individual professional last name
Provider First Name	CHARLOTTE
	Individual professional first name
Provider Middle Name	M
	Individual professional middle name
Provider Gender	F
	The provider's gender if the provider is a person.

Medical School Information
Medical School Name	OTHER
	Individual professional's medical school
Graduation Year	2008
	Individual professional's medical school graduation year
Primary Specialty	NURSE PRACTITIONER
	Primary medical specialty reported by the individual professional in the selected enrollment

Practice Information
Line 1 Street Address	3550 AIRPORT WAY
	Group Practice or individual's line 1 address
Line 2 Street Address	SUITE 4
	Group Practice or individual's line 2 address
City	FAIRBANKS
	Group Practice or individual's city
State	AK
	Group Practice or individual's state
Zip Code	997094772
	Group Practice or individual's zip code (9 digits when available)

Hospital(s) Affiliation Information
Hospital Affiliation CCN 1	020012
	Medicare CCN of hospital where individual professional provides service 1
Hospital Affiliation LBN 1	FAIRBANKS MEMORIAL HOSPITAL
	Legal business name of hospital where individual professional provides service 1
Professional Accepts Medicare Assignment	M