Physician Compare National (NPI:1790778611)

HEALTHCARE PROVIDER: TERRYL DEWAYNE TIMES 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	1790778611
	Unique healthcare provider (clinician) ID assigned by NPPES
PECOS UID	3971600768
	Unique individual clinician ID assigned by PECOS
Professional Enrollment ID	I20070511000388
	Unique ID for the individual professional enrollment that is the source for the data in the observation
Provider Last Name	TIMES
	Individual professional last name
Provider First Name	TERRYL
	Individual professional first name
Provider Middle Name	D
	Individual professional middle name
Provider Gender	M
	The provider's gender if the provider is a person.
Provider Credential Text	MD
	The abbreviations for professional degrees or credentials used or held by the provider, if the provider is an individual. Examples are MD, DDS, CSW, CNA, AA, NP, RNA, or PSY. These credential designations will not be verified by NPS.

Medical School Information
Medical School Name	UNIVERSITY OF TEXAS MEDICAL BRANCH AT GALVESTON
	Individual professional's medical school
Graduation Year	1986
	Individual professional's medical school graduation year
Primary Specialty	GENERAL SURGERY
	Primary medical specialty reported by the individual professional in the selected enrollment

Practice Information
Organization Legal Name	SENTARA MEDICAL GROUP
	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	8921903923
	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	852
	Total number of individual professionals affiliated with the Group Practice based on Group Practice PAC ID
Line 1 Street Address	500 SENTARA CIRCLE
	Group Practice or individual's line 1 address
Line 2 Street Address	SUITE 202
	Group Practice or individual's line 2 address
City	WILLIAMSBURG
	Group Practice or individual's city
State	VA
	Group Practice or individual's state
Zip Code	231885727
	Group Practice or individual's zip code (9 digits when available)
Phone Number	7579849850
	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	490066
	Medicare CCN of hospital where individual professional provides service 1
Hospital Affiliation LBN 1	SENTARA WILLIAMSBURG REGIONAL MEDICAL CENTER
	Legal business name of hospital where individual professional provides service 1
Hospital Affiliation CCN 2	490007
	Medicare CCN of hospital where individual professional provides service 2
Hospital Affiliation LBN 2	SENTARA NORFOLK GENERAL HOSPITAL
	Legal business name of hospital where individual professional provides service 2
Professional Accepts Medicare Assignment	Y