Physician Compare National (NPI:1760699540)

HEALTHCARE PROVIDER: DANNY ELLIS NP

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

Individual Professional Information
NPI	1760699540
	Unique healthcare provider (clinician) ID assigned by NPPES
PECOS UID	9537252648
	Unique individual clinician ID assigned by PECOS
Professional Enrollment ID	I20150223001068
	Unique ID for the individual professional enrollment that is the source for the data in the observation
Provider Last Name	ELLIS
	Individual professional last name
Provider First Name	DAN
	Individual professional first name
Provider Middle Name	E
	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	2006
	Individual professional's medical school graduation year
Primary Specialty	NURSE PRACTITIONER
	Primary medical specialty reported by the individual professional in the selected enrollment

Practice Information
Line 1 Street Address	32 CROTHERS DR
	Group Practice or individual's line 1 address
City	TALLULAH
	Group Practice or individual's city
State	LA
	Group Practice or individual's state
Zip Code	712825510
	Group Practice or individual's zip code (9 digits when available)

Hospital(s) Affiliation Information
Hospital Affiliation CCN 1	251320
	Medicare CCN of hospital where individual professional provides service 1
Hospital Affiliation LBN 1	CLAIBORNE COUNTY HOSPITAL
	Legal business name of hospital where individual professional provides service 1
Hospital Affiliation CCN 2	250048
	Medicare CCN of hospital where individual professional provides service 2
Hospital Affiliation LBN 2	ST DOMINIC-JACKSON MEMORIAL HOSPITAL
	Legal business name of hospital where individual professional provides service 2
Professional Accepts Medicare Assignment	Y