Physician Compare National (NPI:1770083446)

HEALTHCARE PROVIDER: DOUGLAS NOLAND BENNETT DPT, CSCS

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

Individual Professional Information
NPI	1770083446
	Unique healthcare provider (clinician) ID assigned by NPPES
PECOS UID	4587927157
	Unique individual clinician ID assigned by PECOS
Professional Enrollment ID	I20180412001049
	Unique ID for the individual professional enrollment that is the source for the data in the observation
Provider Last Name	BENNETT
	Individual professional last name
Provider First Name	DOUGLAS
	Individual professional first name
Provider Middle Name	NOLAND
	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	2017
	Individual professional's medical school graduation year
Primary Specialty	PHYSICAL THERAPY
	Primary medical specialty reported by the individual professional in the selected enrollment

Practice Information
Organization Legal Name	ADVANCE SPORTS AND SPINE THERAPY, LLC
	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	2567457104
	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	8
	Total number of individual professionals affiliated with the Group Practice based on Group Practice PAC ID
Line 1 Street Address	25030 SW PKWY AVE
	Group Practice or individual's line 1 address
Line 2 Street Address	SUITE 101
	Group Practice or individual's line 2 address
City	WILSONVILLE
	Group Practice or individual's city
State	OR
	Group Practice or individual's state
Zip Code	970709816
	Group Practice or individual's zip code (9 digits when available)
Phone Number	5035821073
	Phone number is listed only when there is a single phone number available for the practice location address

Hospital(s) Affiliation Information
Professional Accepts Medicare Assignment	Y