Physician Compare National (NPI:1790890796)

HEALTHCARE PROVIDER: CHARLES M GRADE 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	1790890796
	Unique healthcare provider (clinician) ID assigned by NPPES
PECOS UID	2668534355
	Unique individual clinician ID assigned by PECOS
Professional Enrollment ID	I20081213000232
	Unique ID for the individual professional enrollment that is the source for the data in the observation
Provider Last Name	GRADE
	Individual professional last name
Provider First Name	CHARLES
	Individual professional first name
Provider Middle Name	M
	Individual professional middle name
Provider Gender	M
	The provider's gender if the provider is a person.

Medical School Information
Medical School Name	UNIVERSITY OF WISCONSIN SCHOOL OF MEDICINE
	Individual professional's medical school
Graduation Year	1989
	Individual professional's medical school graduation year
Primary Specialty	PSYCHIATRY
	Primary medical specialty reported by the individual professional in the selected enrollment
Secondary Specialty 1	ADDICTION MEDICINE
	First secondary medical specialty reported by the individual professional in the selected enrollment
All Secondary Specialties	ADDICTION MEDICINE
	All four secondary specialties reported by the individual professional in the selected enrollment, separated by commas

Practice Information
Line 1 Street Address	930 E KNAPP ST
	Group Practice or individual's line 1 address
Line 2 Street Address	SUITE 22
	Group Practice or individual's line 2 address
City	MILWAUKEE
	Group Practice or individual's city
State	WI
	Group Practice or individual's state
Zip Code	532022800
	Group Practice or individual's zip code (9 digits when available)

Hospital(s) Affiliation Information
Hospital Affiliation CCN 1	520027
	Medicare CCN of hospital where individual professional provides service 1
Hospital Affiliation LBN 1	COLUMBIA ST MARYS HOSPITAL OZAUKEE
	Legal business name of hospital where individual professional provides service 1
Professional Accepts Medicare Assignment	Y