Physician Compare National (NPI:1780722157)

HEALTHCARE PROVIDER: DON OTT PSY.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	1780722157
	Unique healthcare provider (clinician) ID assigned by NPPES
PECOS UID	0345432555
	Unique individual clinician ID assigned by PECOS
Professional Enrollment ID	I20101006000858
	Unique ID for the individual professional enrollment that is the source for the data in the observation
Provider Last Name	OTT
	Individual professional last name
Provider First Name	DON
	Individual professional first 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	1987
	Individual professional's medical school graduation year
Primary Specialty	PSYCHOLOGIST, CLINICAL
	Primary medical specialty reported by the individual professional in the selected enrollment

Practice Information
Line 1 Street Address	2621 W MAIN ST
	Group Practice or individual's line 1 address
Line 2 Street Address	SUITE 4
	Group Practice or individual's line 2 address
City	RUSSELLVILLE
	Group Practice or individual's city
State	AR
	Group Practice or individual's state
Zip Code	728012551
	Group Practice or individual's zip code (9 digits when available)
Phone Number	4799673700
	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