Physician Compare National (NPI:1801869789)

HEALTHCARE PROVIDER: ERIK STEPHEN STORM D.O.

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

Individual Professional Information
NPI	1801869789
	Unique healthcare provider (clinician) ID assigned by NPPES
PECOS UID	6608969522
	Unique individual clinician ID assigned by PECOS
Professional Enrollment ID	I20100729000410
	Unique ID for the individual professional enrollment that is the source for the data in the observation
Provider Last Name	STORM
	Individual professional last name
Provider First Name	ERIK
	Individual professional first name
Provider Middle Name	STEPHEN
	Individual professional middle name
Provider Gender	M
	The provider's gender if the provider is a person.

Medical School Information
Medical School Name	PHILADELPHIA COLLEGE OF OSTEOPATHIC MEDICINE
	Individual professional's medical school
Graduation Year	2001
	Individual professional's medical school graduation year
Primary Specialty	DIAGNOSTIC RADIOLOGY
	Primary medical specialty reported by the individual professional in the selected enrollment

Practice Information
Organization Legal Name	ROANOKE IMAGING 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	9436215662
	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	6
	Total number of individual professionals affiliated with the Group Practice based on Group Practice PAC ID
Line 1 Street Address	4330 BRAMBLETON AVE
	Group Practice or individual's line 1 address
City	ROANOKE
	Group Practice or individual's city
State	VA
	Group Practice or individual's state
Zip Code	240183405
	Group Practice or individual's zip code (9 digits when available)
Phone Number	5402833700
	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	490021
	Medicare CCN of hospital where individual professional provides service 1
Hospital Affiliation LBN 1	CENTRA
	Legal business name of hospital where individual professional provides service 1
Hospital Affiliation CCN 2	380009
	Medicare CCN of hospital where individual professional provides service 2
Hospital Affiliation LBN 2	OHSU HOSPITAL
	Legal business name of hospital where individual professional provides service 2
Hospital Affiliation CCN 3	490048
	Medicare CCN of hospital where individual professional provides service 3
Hospital Affiliation LBN 3	LEWISGALE MEDICAL CENTER
	Legal business name of hospital where individual professional provides service 3
Professional Accepts Medicare Assignment	M