Physician Compare National (NPI:1730289034)

HEALTHCARE PROVIDER: TODD MICHAEL FOGARTY CRNA

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

Individual Professional Information
NPI	1730289034
	Unique healthcare provider (clinician) ID assigned by NPPES
PECOS UID	1254460553
	Unique individual clinician ID assigned by PECOS
Professional Enrollment ID	I20100525000751
	Unique ID for the individual professional enrollment that is the source for the data in the observation
Provider Last Name	FOGARTY
	Individual professional last name
Provider First Name	TODD
	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	OTHER
	Individual professional's medical school
Graduation Year	1986
	Individual professional's medical school graduation year
Primary Specialty	CERTIFIED REGISTERED NURSE ANESTHETIST (CRNA)
	Primary medical specialty reported by the individual professional in the selected enrollment

Practice Information
Line 1 Street Address	100 VALLEY DR
	Group Practice or individual's line 1 address
City	PAULS VALLEY
	Group Practice or individual's city
State	OK
	Group Practice or individual's state
Zip Code	730756613
	Group Practice or individual's zip code (9 digits when available)
Phone Number	4052385501
	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	370220
	Medicare CCN of hospital where individual professional provides service 1
Hospital Affiliation LBN 1	ONECORE HEALTH
	Legal business name of hospital where individual professional provides service 1
Professional Accepts Medicare Assignment	Y