Individual Professional Information |
|
NPI
|
1790940658
|
|
Unique healthcare provider (clinician) ID assigned by NPPES
|
|
PECOS UID
|
0547431470
|
|
Unique individual clinician ID assigned by PECOS
|
|
Professional Enrollment ID
|
I20150406000768
|
|
Unique ID for the individual professional enrollment that is the source for the data in the observation
|
|
Provider Last Name
|
NWADIBIA
|
|
Individual professional last name
|
|
Provider First Name
|
OBINNA
|
|
Individual professional first name
|
|
Provider Middle Name
|
E
|
|
Individual professional middle name
|
|
Provider Gender
|
M
|
|
The provider's gender if the provider is a person.
|
Practice Information |
|
Organization Legal Name
|
HAWARDEN REGIONAL HEALTHCARE
|
|
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
|
0547257990
|
|
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
|
12
|
|
Total number of individual professionals affiliated with the Group Practice based on Group Practice PAC ID
|
|
Line 1 Street Address
|
1111 11TH ST
|
|
Group Practice or individual's line 1 address
|
|
City
|
HAWARDEN
|
|
Group Practice or individual's city
|
|
State
|
IA
|
|
Group Practice or individual's state
|
|
Zip Code
|
510231903
|
|
Group Practice or individual's zip code (9 digits when available)
|
|
Phone Number
|
7125513100
|
|
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
|
430027
|
|
Medicare CCN of hospital where individual professional provides service 1
|
|
Hospital Affiliation LBN 1
|
SANFORD USD MEDICAL CENTER
|
|
Legal business name of hospital where individual professional provides service 1
|
|
Hospital Affiliation CCN 2
|
241371
|
|
Medicare CCN of hospital where individual professional provides service 2
|
|
Hospital Affiliation LBN 2
|
SANFORD LUVERNE MEDICAL CENTER
|
|
Legal business name of hospital where individual professional provides service 2
|
|
Hospital Affiliation CCN 3
|
241332
|
|
Medicare CCN of hospital where individual professional provides service 3
|
|
Hospital Affiliation LBN 3
|
WINDOM AREA HOSPITAL
|
|
Legal business name of hospital where individual professional provides service 3
|
|
Hospital Affiliation CCN 4
|
241369
|
|
Medicare CCN of hospital where individual professional provides service 4
|
|
Hospital Affiliation LBN 4
|
UNITED HOSPITAL DISTRICT
|
|
Legal business name of hospital where individual professional provides service 4
|
|
Hospital Affiliation CCN 5
|
241377
|
|
Medicare CCN of hospital where individual professional provides service 5
|
|
Hospital Affiliation LBN 5
|
ST FRANCIS MEDICAL CENTER
|
|
Legal business name of hospital where individual professional provides service 5
|
|
Professional Accepts Medicare Assignment
|
Y
|
|
|