Physician Compare National (NPI:1770922254)

HEALTHCARE PROVIDER: CLAIRE WALLACE M.D.

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

Individual Professional Information
NPI	1770922254
	Unique healthcare provider (clinician) ID assigned by NPPES
PECOS UID	4486931201
	Unique individual clinician ID assigned by PECOS
Professional Enrollment ID	I20170504001160
	Unique ID for the individual professional enrollment that is the source for the data in the observation
Provider Last Name	WALLACE
	Individual professional last name
Provider First Name	CLAIRE
	Individual professional first name
Provider Middle Name	MICHELLE
	Individual professional middle name
Provider Gender	F
	The provider's gender if the provider is a person.

Medical School Information
Medical School Name	OTHER
	Individual professional's medical school
Graduation Year	2011
	Individual professional's medical school graduation year
Primary Specialty	FAMILY MEDICINE
	Primary medical specialty reported by the individual professional in the selected enrollment

Practice Information
Organization Legal Name	HIGHLAND MEDICAL CENTER 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	1759285075
	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	120 JACKSON RIVER RD
	Group Practice or individual's line 1 address
City	MONTEREY
	Group Practice or individual's city
State	VA
	Group Practice or individual's state
Zip Code	244652416
	Group Practice or individual's zip code (9 digits when available)
Phone Number	5404683300
	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	490018
	Medicare CCN of hospital where individual professional provides service 1
Hospital Affiliation LBN 1	AUGUSTA HEALTH
	Legal business name of hospital where individual professional provides service 1
Hospital Affiliation CCN 2	490004
	Medicare CCN of hospital where individual professional provides service 2
Hospital Affiliation LBN 2	SENTARA RMH MEDICAL CENTER
	Legal business name of hospital where individual professional provides service 2
Hospital Affiliation CCN 3	491300
	Medicare CCN of hospital where individual professional provides service 3
Hospital Affiliation LBN 3	BATH COMMUNITY HOSPITAL
	Legal business name of hospital where individual professional provides service 3
Hospital Affiliation CCN 4	490009
	Medicare CCN of hospital where individual professional provides service 4
Hospital Affiliation LBN 4	UNIVERSITY OF VIRGINIA MEDICAL CENTER
	Legal business name of hospital where individual professional provides service 4
Professional Accepts Medicare Assignment	Y