Physician Compare National (NPI:1770587404)

HEALTHCARE PROVIDER: WILLIAM G TABBERT D.P.M.

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

Individual Professional Information
NPI	1770587404
	Unique healthcare provider (clinician) ID assigned by NPPES
PECOS UID	8022102763
	Unique individual clinician ID assigned by PECOS
Professional Enrollment ID	I20100329000134
	Unique ID for the individual professional enrollment that is the source for the data in the observation
Provider Last Name	TABBERT
	Individual professional last name
Provider First Name	WILLIAM
	Individual professional first name
Provider Middle Name	GROVER
	Individual professional middle name
Provider Gender	M
	The provider's gender if the provider is a person.

Medical School Information
Medical School Name	ILLINOIS MEDICAL COLLEGE
	Individual professional's medical school
Graduation Year	1981
	Individual professional's medical school graduation year
Primary Specialty	PODIATRY
	Primary medical specialty reported by the individual professional in the selected enrollment

Practice Information
Line 1 Street Address	1125 ELLEN KAY DR
	Group Practice or individual's line 1 address
Line 2 Street Address	SUITE E
	Group Practice or individual's line 2 address
City	MARION
	Group Practice or individual's city
State	OH
	Group Practice or individual's state
Zip Code	433026358
	Group Practice or individual's zip code (9 digits when available)
Phone Number	7403872274
	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	360011
	Medicare CCN of hospital where individual professional provides service 1
Hospital Affiliation LBN 1	MARION GENERAL HOSPITAL
	Legal business name of hospital where individual professional provides service 1
Professional Accepts Medicare Assignment	Y