Physician Compare National (NPI:1790733590)

HEALTHCARE PROVIDER: JOHN FITZGERALD ANSLEY MD

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

Individual Professional Information
NPI	1790733590
	Unique healthcare provider (clinician) ID assigned by NPPES
PECOS UID	7214074756
	Unique individual clinician ID assigned by PECOS
Professional Enrollment ID	I20120125000528
	Unique ID for the individual professional enrollment that is the source for the data in the observation
Provider Last Name	ANSLEY
	Individual professional last name
Provider First Name	JOHN
	Individual professional first name
Provider Middle Name	FITZGERALD
	Individual professional middle name
Provider Gender	M
	The provider's gender if the provider is a person.

Medical School Information
Medical School Name	JS WEILL MEDICAL COLLEGE, CORNELL UNIVERSITY
	Individual professional's medical school
Graduation Year	1994
	Individual professional's medical school graduation year
Primary Specialty	OTOLARYNGOLOGY
	Primary medical specialty reported by the individual professional in the selected enrollment

Practice Information
Organization Legal Name	CHARLESTON ENT ASSOCIATES, 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	4082662234
	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	45
	Total number of individual professionals affiliated with the Group Practice based on Group Practice PAC ID
Line 1 Street Address	2295 HENRY TECKLENBURG DR
	Group Practice or individual's line 1 address
City	CHARLESTON
	Group Practice or individual's city
State	SC
	Group Practice or individual's state
Zip Code	294147801
	Group Practice or individual's zip code (9 digits when available)
Phone Number	8437667103
	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	420068
	Medicare CCN of hospital where individual professional provides service 1
Hospital Affiliation LBN 1	TRMC OF ORANGEBURG & CALHOUN
	Legal business name of hospital where individual professional provides service 1
Hospital Affiliation CCN 2	420030
	Medicare CCN of hospital where individual professional provides service 2
Hospital Affiliation LBN 2	COLLETON MEDICAL CENTER
	Legal business name of hospital where individual professional provides service 2
Professional Accepts Medicare Assignment	Y