Physician Compare National (NPI:1811379092)

HEALTHCARE PROVIDER: MICHAEL THADDEUS STANEK 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	1811379092
	Unique healthcare provider (clinician) ID assigned by NPPES
PECOS UID	5890090575
	Unique individual clinician ID assigned by PECOS
Professional Enrollment ID	I20180618000574
	Unique ID for the individual professional enrollment that is the source for the data in the observation
Provider Last Name	STANEK
	Individual professional last name
Provider First Name	MICHAEL
	Individual professional first name
Provider Middle Name	T
	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 ILLINOIS COLLEGE OF MED (CHI/PEOR/ROCK/CHM-URB)
	Individual professional's medical school
Graduation Year	2014
	Individual professional's medical school graduation year
Primary Specialty	EMERGENCY MEDICINE
	Primary medical specialty reported by the individual professional in the selected enrollment

Practice Information
Organization Legal Name	APP OF INDIANA ED, PLLC
	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	2961835400
	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	104
	Total number of individual professionals affiliated with the Group Practice based on Group Practice PAC ID
Line 1 Street Address	303 S MAIN ST
	Group Practice or individual's line 1 address
City	BLUFFTON
	Group Practice or individual's city
State	IN
	Group Practice or individual's state
Zip Code	467142503
	Group Practice or individual's zip code (9 digits when available)
Phone Number	2608243210
	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	150150
	Medicare CCN of hospital where individual professional provides service 1
Hospital Affiliation LBN 1	DUPONT HOSPITAL LLC
	Legal business name of hospital where individual professional provides service 1
Hospital Affiliation CCN 2	150047
	Medicare CCN of hospital where individual professional provides service 2
Hospital Affiliation LBN 2	ST JOSEPH HOSPITAL
	Legal business name of hospital where individual professional provides service 2
Hospital Affiliation CCN 3	150017
	Medicare CCN of hospital where individual professional provides service 3
Hospital Affiliation LBN 3	LUTHERAN HOSPITAL OF INDIANA
	Legal business name of hospital where individual professional provides service 3
Professional Accepts Medicare Assignment	Y