Physician Compare National (NPI:1659784338)

HEALTHCARE PROVIDER: BLAKE PUTMAN M.D.

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

Individual Professional Information
NPI	1659784338
	Unique healthcare provider (clinician) ID assigned by NPPES
PECOS UID	3870884547
	Unique individual clinician ID assigned by PECOS
Professional Enrollment ID	I20171005002403
	Unique ID for the individual professional enrollment that is the source for the data in the observation
Provider Last Name	PUTMAN
	Individual professional last name
Provider First Name	BLAKE
	Individual professional first name
Provider Gender	M
	The provider's gender if the provider is a person.

Medical School Information
Medical School Name	OTHER
	Individual professional's medical school
Graduation Year	2014
	Individual professional's medical school graduation year
Primary Specialty	FAMILY MEDICINE
	Primary medical specialty reported by the individual professional in the selected enrollment

Practice Information
Organization Legal Name	HILLS AND DALES GENERAL HOSPITAL INC
	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	8022910363
	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	26
	Total number of individual professionals affiliated with the Group Practice based on Group Practice PAC ID
Line 1 Street Address	1514 W CARO RD
	Group Practice or individual's line 1 address
City	CARO
	Group Practice or individual's city
State	MI
	Group Practice or individual's state
Zip Code	487239260
	Group Practice or individual's zip code (9 digits when available)
Phone Number	9896721399
	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	231316
	Medicare CCN of hospital where individual professional provides service 1
Hospital Affiliation LBN 1	HILLS & DALES GENERAL HOSPITAL
	Legal business name of hospital where individual professional provides service 1
Hospital Affiliation CCN 2	231329
	Medicare CCN of hospital where individual professional provides service 2
Hospital Affiliation LBN 2	CARO COMMUNITY HOSPITAL
	Legal business name of hospital where individual professional provides service 2
Hospital Affiliation CCN 3	231310
	Medicare CCN of hospital where individual professional provides service 3
Hospital Affiliation LBN 3	SCHEURER HOSPITAL
	Legal business name of hospital where individual professional provides service 3
Hospital Affiliation CCN 4	230070
	Medicare CCN of hospital where individual professional provides service 4
Hospital Affiliation LBN 4	COVENANT MEDICAL CENTER
	Legal business name of hospital where individual professional provides service 4
Professional Accepts Medicare Assignment	Y