Physician Compare National (NPI:1699772210)

HEALTHCARE PROVIDER: RUSSELL PATRICK GOLLARD 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	1699772210
	Unique healthcare provider (clinician) ID assigned by NPPES
PECOS UID	5395770036
	Unique individual clinician ID assigned by PECOS
Professional Enrollment ID	I20091216000348
	Unique ID for the individual professional enrollment that is the source for the data in the observation
Provider Last Name	GOLLARD
	Individual professional last name
Provider First Name	RUSSELL
	Individual professional first name
Provider Middle Name	P
	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 SOUTHERN CALIFORNIA KECK SCHOOL OF MEDICINE
	Individual professional's medical school
Graduation Year	1990
	Individual professional's medical school graduation year
Primary Specialty	HEMATOLOGY/ONCOLOGY
	Primary medical specialty reported by the individual professional in the selected enrollment

Practice Information
Organization Legal Name	ROBERT B MCBEATH MD PROFESSIONAL CORPORATION
	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	1052390036
	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	74
	Total number of individual professionals affiliated with the Group Practice based on Group Practice PAC ID
Line 1 Street Address	6190 S FORT APACHE RD
	Group Practice or individual's line 1 address
City	LAS VEGAS
	Group Practice or individual's city
State	NV
	Group Practice or individual's state
Zip Code	891486702
	Group Practice or individual's zip code (9 digits when available)
Phone Number	7027248787
	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	290007
	Medicare CCN of hospital where individual professional provides service 1
Hospital Affiliation LBN 1	UNIVERSITY MEDICAL CENTER
	Legal business name of hospital where individual professional provides service 1
Hospital Affiliation CCN 2	290045
	Medicare CCN of hospital where individual professional provides service 2
Hospital Affiliation LBN 2	ST ROSE DOMINICAN HOSPITALS - SIENA CAMPUS
	Legal business name of hospital where individual professional provides service 2
Hospital Affiliation CCN 3	290046
	Medicare CCN of hospital where individual professional provides service 3
Hospital Affiliation LBN 3	SPRING VALLEY HOSPITAL MEDICAL CENTER
	Legal business name of hospital where individual professional provides service 3
Hospital Affiliation CCN 4	290041
	Medicare CCN of hospital where individual professional provides service 4
Hospital Affiliation LBN 4	SUMMERLIN HOSPITAL MEDICAL CENTER
	Legal business name of hospital where individual professional provides service 4
Professional Accepts Medicare Assignment	Y