Physician Compare National (NPI:1700870565)

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	1700870565
	Unique healthcare provider (clinician) ID assigned by NPPES
PECOS UID	7416087259
	Unique individual clinician ID assigned by PECOS
Professional Enrollment ID	I20100604000959
	Unique ID for the individual professional enrollment that is the source for the data in the observation
Provider Last Name	BUTITTA
	Individual professional last name
Provider First Name	JOHN
	Individual professional first name
Provider Middle Name	M
	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 ILLINOIS COLLEGE OF MED (CHI/PEOR/ROCK/CHM-URB)
	Individual professional's medical school
Graduation Year	1975
	Individual professional's medical school graduation year
Primary Specialty	INTERNAL MEDICINE
	Primary medical specialty reported by the individual professional in the selected enrollment

Practice Information
Organization Legal Name	ASCENSION MEDICAL GROUP-FOX VALLEY WISCONSIN, 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	0244142420
	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	255
	Total number of individual professionals affiliated with the Group Practice based on Group Practice PAC ID
Line 1 Street Address	2601 FIELDCREST DR
	Group Practice or individual's line 1 address
City	KAUKAUNA
	Group Practice or individual's city
State	WI
	Group Practice or individual's state
Zip Code	541304523
	Group Practice or individual's zip code (9 digits when available)
Phone Number	9204626100
	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