Physician Compare National (NPI:1699892489)

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	1699892489
	Unique healthcare provider (clinician) ID assigned by NPPES
PECOS UID	1254526916
	Unique individual clinician ID assigned by PECOS
Professional Enrollment ID	I20101109000134
	Unique ID for the individual professional enrollment that is the source for the data in the observation
Provider Last Name	POLONI
	Individual professional last name
Provider First Name	LOUIS
	Individual professional first name
Provider Middle Name	D
	Individual professional middle name
Provider Gender	M
	The provider's gender if the provider is a person.

Medical School Information
Medical School Name	R FRANKLIN UNIVERSITY OF MED & SCI/CHICAGO MEDICAL SCHOOL
	Individual professional's medical school
Graduation Year	1986
	Individual professional's medical school graduation year
Primary Specialty	PSYCHOLOGIST, CLINICAL
	Primary medical specialty reported by the individual professional in the selected enrollment

Practice Information
Line 1 Street Address	2200 S GEORGE ST
	Group Practice or individual's line 1 address
Line 2 Street Address	SUITE W 1
	Group Practice or individual's line 2 address
City	YORK
	Group Practice or individual's city
State	PA
	Group Practice or individual's state
Zip Code	174034594
	Group Practice or individual's zip code (9 digits when available)
Phone Number	7177414071
	Phone number is listed only when there is a single phone number available for the practice location address

Hospital(s) Affiliation Information
Professional Accepts Medicare Assignment	Y