Physician Compare National (NPI:1710942859)

HEALTHCARE PROVIDER: DAVID EUGENE CARLSON JR. 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	1710942859
	Unique healthcare provider (clinician) ID assigned by NPPES
PECOS UID	9436191368
	Unique individual clinician ID assigned by PECOS
Professional Enrollment ID	I20050601000468
	Unique ID for the individual professional enrollment that is the source for the data in the observation
Provider Last Name	CARLSON
	Individual professional last name
Provider First Name	DAVID
	Individual professional first name
Provider Middle Name	E
	Individual professional middle name
Provider Name Suffix Text	JR.
	The name suffix of the provider if the provider is an individual. The name suffix is a ''generation-related'' suffix, such as Jr., Sr., II, III, IV, or V.
Provider Gender	M
	The provider's gender if the provider is a person.
Provider Credential Text	MD
	The abbreviations for professional degrees or credentials used or held by the provider, if the provider is an individual. Examples are MD, DDS, CSW, CNA, AA, NP, RNA, or PSY. These credential designations will not be verified by NPS.

Medical School Information
Medical School Name	STATE UNIVERSITY OF NEW YORK AT BUFFALO SCHOOL OF MEDICINE
	Individual professional's medical school
Graduation Year	1990
	Individual professional's medical school graduation year
Primary Specialty	CARDIOVASCULAR DISEASE (CARDIOLOGY)
	Primary medical specialty reported by the individual professional in the selected enrollment

Practice Information
Organization Legal Name	SUBURBAN CARDIOLOGY PC
	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	5496771164
	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	4
	Total number of individual professionals affiliated with the Group Practice based on Group Practice PAC ID
Line 1 Street Address	831 MAPLE RD
	Group Practice or individual's line 1 address
Line 2 Street Address	SUITE 2
	Group Practice or individual's line 2 address
City	WILLIAMSVILLE
	Group Practice or individual's city
State	NY
	Group Practice or individual's state
Zip Code	142213267
	Group Practice or individual's zip code (9 digits when available)
Phone Number	7165651978
	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	330005
	Medicare CCN of hospital where individual professional provides service 1
Hospital Affiliation LBN 1	KALEIDA HEALTH
	Legal business name of hospital where individual professional provides service 1
Professional Accepts Medicare Assignment	Y