Physician Compare National (NPI:1811221153)

HEALTHCARE PROVIDER: MICHAEL DAVID STORMONT 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	1811221153
	Unique healthcare provider (clinician) ID assigned by NPPES
PECOS UID	7315103322
	Unique individual clinician ID assigned by PECOS
Professional Enrollment ID	I20120719000159
	Unique ID for the individual professional enrollment that is the source for the data in the observation
Provider Last Name	STORMONT
	Individual professional last name
Provider First Name	MICHAEL
	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.

Medical School Information
Medical School Name	OTHER
	Individual professional's medical school
Graduation Year	2012
	Individual professional's medical school graduation year
Primary Specialty	FAMILY MEDICINE
	Primary medical specialty reported by the individual professional in the selected enrollment

Practice Information
Organization Legal Name	GALION COMMUNITY HOSPITAL
	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	5496737439
	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	17
	Total number of individual professionals affiliated with the Group Practice based on Group Practice PAC ID
Line 1 Street Address	269 PORTLAND WAY S
	Group Practice or individual's line 1 address
City	GALION
	Group Practice or individual's city
State	OH
	Group Practice or individual's state
Zip Code	448332399
	Group Practice or individual's zip code (9 digits when available)
Phone Number	4194684841
	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	361325
	Medicare CCN of hospital where individual professional provides service 1
Hospital Affiliation LBN 1	GALION COMMUNITY HOSPITAL
	Legal business name of hospital where individual professional provides service 1
Hospital Affiliation CCN 2	360118
	Medicare CCN of hospital where individual professional provides service 2
Hospital Affiliation LBN 2	OHIOHEALTH MANSFIELD HOSPITAL
	Legal business name of hospital where individual professional provides service 2
Hospital Affiliation CCN 3	360365
	Medicare CCN of hospital where individual professional provides service 3
Hospital Affiliation LBN 3	AVITA ONTARIO
	Legal business name of hospital where individual professional provides service 3
Professional Accepts Medicare Assignment	Y