Physician Compare National (NPI:1760402622)

HEALTHCARE PROVIDER: ROBERT A CROCKETT 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	1760402622
	Unique healthcare provider (clinician) ID assigned by NPPES
PECOS UID	3577606888
	Unique individual clinician ID assigned by PECOS
Professional Enrollment ID	I20100309000436
	Unique ID for the individual professional enrollment that is the source for the data in the observation
Provider Last Name	CROCKETT
	Individual professional last name
Provider First Name	ROBERT
	Individual professional first name
Provider Gender	M
	The provider's gender if the provider is a person.

Medical School Information
Medical School Name	UNIVERSITY OF TEXAS MEDICAL SCHOOL AT SAN ANTONIO
	Individual professional's medical school
Graduation Year	1989
	Individual professional's medical school graduation year
Primary Specialty	DIAGNOSTIC RADIOLOGY
	Primary medical specialty reported by the individual professional in the selected enrollment

Practice Information
Organization Legal Name	GRASS VALLEY RADIOLOGY MEDICAL GROUP, 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	4486624103
	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	6
	Total number of individual professionals affiliated with the Group Practice based on Group Practice PAC ID
Line 1 Street Address	155 GLASSON WAY
	Group Practice or individual's line 1 address
City	GRASS VALLEY
	Group Practice or individual's city
State	CA
	Group Practice or individual's state
Zip Code	959455723
	Group Practice or individual's zip code (9 digits when available)
Phone Number	5302746107
	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	050150
	Medicare CCN of hospital where individual professional provides service 1
Hospital Affiliation LBN 1	SIERRA NEVADA MEMORIAL HOSPITAL
	Legal business name of hospital where individual professional provides service 1
Hospital Affiliation CCN 2	050030
	Medicare CCN of hospital where individual professional provides service 2
Hospital Affiliation LBN 2	OROVILLE HOSPITAL
	Legal business name of hospital where individual professional provides service 2
Hospital Affiliation CCN 3	050599
	Medicare CCN of hospital where individual professional provides service 3
Hospital Affiliation LBN 3	UNIVERSITY OF CALIFORNIA DAVIS MEDICAL CENTER
	Legal business name of hospital where individual professional provides service 3
Hospital Affiliation CCN 4	050017
	Medicare CCN of hospital where individual professional provides service 4
Hospital Affiliation LBN 4	MERCY GENERAL HOSPITAL
	Legal business name of hospital where individual professional provides service 4
Professional Accepts Medicare Assignment	Y