Physician Compare National (NPI:1750352621)

HEALTHCARE PROVIDER: MARY ELLEN MAHONEY 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	1750352621
	Unique healthcare provider (clinician) ID assigned by NPPES
PECOS UID	6204986862
	Unique individual clinician ID assigned by PECOS
Professional Enrollment ID	I20090603000116
	Unique ID for the individual professional enrollment that is the source for the data in the observation
Provider Last Name	MAHONEY
	Individual professional last name
Provider First Name	MARY
	Individual professional first name
Provider Gender	F
	The provider's gender if the provider is a person.

Medical School Information
Medical School Name	STANFORD UNIVERSITY SCHOOL OF MEDICINE
	Individual professional's medical school
Graduation Year	1981
	Individual professional's medical school graduation year
Primary Specialty	GENERAL PRACTICE
	Primary medical specialty reported by the individual professional in the selected enrollment

Practice Information
Line 1 Street Address	2504 HARRISON AVE A
	Group Practice or individual's line 1 address
City	EUREKA
	Group Practice or individual's city
State	CA
	Group Practice or individual's state
Zip Code	955013221
	Group Practice or individual's zip code (9 digits when available)
Phone Number	7074760690
	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	050006
	Medicare CCN of hospital where individual professional provides service 1
Hospital Affiliation LBN 1	ST JOSEPH HOSPITAL
	Legal business name of hospital where individual professional provides service 1
Professional Accepts Medicare Assignment	Y