Physician Compare National (NPI:1770978074)

HEALTHCARE PROVIDER: SHELLY DIANE SEDBERRY 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	1770978074
	Unique healthcare provider (clinician) ID assigned by NPPES
PECOS UID	8426379041
	Unique individual clinician ID assigned by PECOS
Professional Enrollment ID	I20180523000729
	Unique ID for the individual professional enrollment that is the source for the data in the observation
Provider Last Name	SEDBERRY
	Individual professional last name
Provider First Name	SHELLY
	Individual professional first name
Provider Middle Name	DIANE
	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	2015
	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	1801 W 32ND ST
	Group Practice or individual's line 1 address
Line 2 Street Address	BUILDING C SUITE 102
	Group Practice or individual's line 2 address
City	JOPLIN
	Group Practice or individual's city
State	MO
	Group Practice or individual's state
Zip Code	648041528
	Group Practice or individual's zip code (9 digits when available)

Hospital(s) Affiliation Information
Hospital Affiliation CCN 1	260001
	Medicare CCN of hospital where individual professional provides service 1
Hospital Affiliation LBN 1	MERCY HOSPITAL JOPLIN
	Legal business name of hospital where individual professional provides service 1
Professional Accepts Medicare Assignment	Y