Physician Compare National (NPI:1720085699)

HEALTHCARE PROVIDER: CLYDE R ROY III MD

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

Individual Professional Information
NPI	1720085699
	Unique healthcare provider (clinician) ID assigned by NPPES
PECOS UID	0648337493
	Unique individual clinician ID assigned by PECOS
Professional Enrollment ID	I20100823000234
	Unique ID for the individual professional enrollment that is the source for the data in the observation
Provider Last Name	ROY
	Individual professional last name
Provider First Name	CLYDE
	Individual professional first name
Provider Middle Name	R
	Individual professional middle name
Provider Name Suffix Text	II
	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.

Medical School Information
Medical School Name	OTHER
	Individual professional's medical school
Graduation Year	1982
	Individual professional's medical school graduation year
Primary Specialty	UROLOGY
	Primary medical specialty reported by the individual professional in the selected enrollment

Practice Information
Organization Legal Name	IBERIA MEDICAL CENTER PHYSICIAN PRACTICE NETWORK
	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	3476730847
	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	20
	Total number of individual professionals affiliated with the Group Practice based on Group Practice PAC ID
Line 1 Street Address	2308 E MAIN ST B
	Group Practice or individual's line 1 address
City	NEW IBERIA
	Group Practice or individual's city
State	LA
	Group Practice or individual's state
Zip Code	705604031
	Group Practice or individual's zip code (9 digits when available)
Phone Number	3373653541
	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	190054
	Medicare CCN of hospital where individual professional provides service 1
Hospital Affiliation LBN 1	IBERIA MEDICAL CENTER
	Legal business name of hospital where individual professional provides service 1
Hospital Affiliation CCN 2	191310
	Medicare CCN of hospital where individual professional provides service 2
Hospital Affiliation LBN 2	FRANKLIN FOUNDATION HOSPITAL
	Legal business name of hospital where individual professional provides service 2
Hospital Affiliation CCN 3	190034
	Medicare CCN of hospital where individual professional provides service 3
Hospital Affiliation LBN 3	ABBEVILLE GENERAL HOSPITAL
	Legal business name of hospital where individual professional provides service 3
Hospital Affiliation CCN 4	190102
	Medicare CCN of hospital where individual professional provides service 4
Hospital Affiliation LBN 4	OUR LADY OF LOURDES REGIONAL MEDICAL CENTER, INC
	Legal business name of hospital where individual professional provides service 4
Professional Accepts Medicare Assignment	Y