Physician Compare National (NPI:1700805652)

HEALTHCARE PROVIDER: MICHAEL JOSEPH CUSATIS DDS

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

Individual Professional Information
NPI	1700805652
	Unique healthcare provider (clinician) ID assigned by NPPES
PECOS UID	1456411776
	Unique individual clinician ID assigned by PECOS
Professional Enrollment ID	I20081117000556
	Unique ID for the individual professional enrollment that is the source for the data in the observation
Provider Last Name	CUSATIS
	Individual professional last name
Provider First Name	MICHAEL
	Individual professional first name
Provider Middle Name	J
	Individual professional middle 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	1990
	Individual professional's medical school graduation year
Primary Specialty	MAXILLOFACIAL SURGERY
	Primary medical specialty reported by the individual professional in the selected enrollment
Secondary Specialty 1	ORAL SURGERY
	First secondary medical specialty reported by the individual professional in the selected enrollment
All Secondary Specialties	ORAL SURGERY
	All four secondary specialties reported by the individual professional in the selected enrollment, separated by commas

Practice Information
Line 1 Street Address	1507 S OTSEGO AVE
	Group Practice or individual's line 1 address
Line 2 Street Address	SUITE B
	Group Practice or individual's line 2 address
City	GAYLORD
	Group Practice or individual's city
State	MI
	Group Practice or individual's state
Zip Code	497359524
	Group Practice or individual's zip code (9 digits when available)

Hospital(s) Affiliation Information
Hospital Affiliation CCN 1	230029
	Medicare CCN of hospital where individual professional provides service 1
Hospital Affiliation LBN 1	ST JOSEPH MERCY OAKLAND
	Legal business name of hospital where individual professional provides service 1
Professional Accepts Medicare Assignment	Y