Physician Compare National (NPI:1801054440)

HEALTHCARE PROVIDER: AIMEE ELIZABETH WIDNER M.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	1801054440
	Unique healthcare provider (clinician) ID assigned by NPPES
PECOS UID	5294999553
	Unique individual clinician ID assigned by PECOS
Professional Enrollment ID	I20161021000940
	Unique ID for the individual professional enrollment that is the source for the data in the observation
Provider Last Name	WIDNER
	Individual professional last name
Provider First Name	AIMEE
	Individual professional first name
Provider Middle Name	E
	Individual professional middle name
Provider Gender	F
	The provider's gender if the provider is a person.

Medical School Information
Medical School Name	OTHER
	Individual professional's medical school
Graduation Year	2008
	Individual professional's medical school graduation year
Primary Specialty	PHYSICAL MEDICINE AND REHABILITATION
	Primary medical specialty reported by the individual professional in the selected enrollment

Practice Information
Line 1 Street Address	746 WILBURN RD
	Group Practice or individual's line 1 address
Line 2 Street Address	SPINE SPECIALTY CLINIC OF ARKANSAS
	Group Practice or individual's line 2 address
City	HEBER SPRINGS
	Group Practice or individual's city
State	AR
	Group Practice or individual's state
Zip Code	725438902
	Group Practice or individual's zip code (9 digits when available)

Hospital(s) Affiliation Information
Hospital Affiliation CCN 1	041312
	Medicare CCN of hospital where individual professional provides service 1
Hospital Affiliation LBN 1	BAPTIST HEALTH MEDICAL CENTER HEBER SPINGS
	Legal business name of hospital where individual professional provides service 1
Hospital Affiliation CCN 2	041313
	Medicare CCN of hospital where individual professional provides service 2
Hospital Affiliation LBN 2	OZARK HEALTH
	Legal business name of hospital where individual professional provides service 2
Professional Accepts Medicare Assignment	Y