Physician Compare National (NPI:1689056939)

HEALTHCARE PROVIDER: JUSTIN G PEDERSEN PA-C

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

Individual Professional Information
NPI	1689056939
	Unique healthcare provider (clinician) ID assigned by NPPES
PECOS UID	7618284225
	Unique individual clinician ID assigned by PECOS
Professional Enrollment ID	I20150915001400
	Unique ID for the individual professional enrollment that is the source for the data in the observation
Provider Last Name	PEDERSEN
	Individual professional last name
Provider First Name	JUSTIN
	Individual professional first name
Provider Gender	M
	The provider's gender if the provider is a person.

Medical School Information
Medical School Name	ALBANY MEDICAL COLLEGE OF UNION UNIVERSITY
	Individual professional's medical school
Graduation Year	2015
	Individual professional's medical school graduation year
Primary Specialty	PHYSICIAN ASSISTANT
	Primary medical specialty reported by the individual professional in the selected enrollment

Practice Information
Organization Legal Name	BASSETT HEALTHCARE
	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	3779488325
	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	574
	Total number of individual professionals affiliated with the Group Practice based on Group Practice PAC ID
Line 1 Street Address	39 PEARL ST W
	Group Practice or individual's line 1 address
City	SIDNEY
	Group Practice or individual's city
State	NY
	Group Practice or individual's state
Zip Code	138381330
	Group Practice or individual's zip code (9 digits when available)
Phone Number	6075612021
	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	330085
	Medicare CCN of hospital where individual professional provides service 1
Hospital Affiliation LBN 1	AURELIA OSBORN FOX MEMORIAL HOSPITAL
	Legal business name of hospital where individual professional provides service 1
Hospital Affiliation CCN 2	330136
	Medicare CCN of hospital where individual professional provides service 2
Hospital Affiliation LBN 2	BASSETT HEALTHCARE
	Legal business name of hospital where individual professional provides service 2
Professional Accepts Medicare Assignment	Y