Physician Compare National (NPI:1760463632)

HEALTHCARE PROVIDER: BENJAMIN W LIGHT M.D., F.A.C.S.

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

Individual Professional Information
NPI	1760463632
	Unique healthcare provider (clinician) ID assigned by NPPES
PECOS UID	2961482260
	Unique individual clinician ID assigned by PECOS
Professional Enrollment ID	I20101012001160
	Unique ID for the individual professional enrollment that is the source for the data in the observation
Provider Last Name	LIGHT
	Individual professional last name
Provider First Name	BENJAMIN
	Individual professional first name
Provider Middle Name	WAYNE
	Individual professional middle name
Provider Gender	M
	The provider's gender if the provider is a person.

Medical School Information
Medical School Name	UNIVERSITY OF ILLINOIS COLLEGE OF MED (CHI/PEOR/ROCK/CHM-URB)
	Individual professional's medical school
Graduation Year	1994
	Individual professional's medical school graduation year
Primary Specialty	OTOLARYNGOLOGY
	Primary medical specialty reported by the individual professional in the selected enrollment

Practice Information
Organization Legal Name	DECATUR ENT ASSOC., P.C.
	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	2163478629
	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	5
	Total number of individual professionals affiliated with the Group Practice based on Group Practice PAC ID
Line 1 Street Address	1218 13TH AVE SE
	Group Practice or individual's line 1 address
City	DECATUR
	Group Practice or individual's city
State	AL
	Group Practice or individual's state
Zip Code	356014307
	Group Practice or individual's zip code (9 digits when available)
Phone Number	2563556200
	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	010085
	Medicare CCN of hospital where individual professional provides service 1
Hospital Affiliation LBN 1	DECATUR MORGAN HOSPITAL - DECATUR CAMPUS
	Legal business name of hospital where individual professional provides service 1
Professional Accepts Medicare Assignment	Y