Physician Compare National (NPI:1821010554)

HEALTHCARE PROVIDER:

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

Individual Professional Information
NPI	1821010554
	Unique healthcare provider (clinician) ID assigned by NPPES
PECOS UID	2062694953
	Unique individual clinician ID assigned by PECOS
Professional Enrollment ID	I20110315000010
	Unique ID for the individual professional enrollment that is the source for the data in the observation
Provider Last Name	STANBERY
	Individual professional last name
Provider First Name	WILLIAM
	Individual professional first name
Provider Middle Name	CECIL
	Individual professional middle name
Provider Name Suffix Text	II
	The name suffix of the provider if the provider is an individual. The name suffix is a ''generation-related'' suffix, such as Jr., Sr., II, III, IV, or V.
Provider Gender	M
	The provider's gender if the provider is a person.

Medical School Information
Medical School Name	UNIVERSITY OF TENNESSEE, HSC, COLLEGE OF MEDICINE
	Individual professional's medical school
Graduation Year	1985
	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
Line 1 Street Address	424 BERYWOOD NWTRL
	Group Practice or individual's line 1 address
City	CLEVELAND
	Group Practice or individual's city
State	TN
	Group Practice or individual's state
Zip Code	373125251
	Group Practice or individual's zip code (9 digits when available)
Phone Number	4234798981
	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	440185
	Medicare CCN of hospital where individual professional provides service 1
Hospital Affiliation LBN 1	TENNOVA HEALTH CARE-CLEVELAND
	Legal business name of hospital where individual professional provides service 1
Professional Accepts Medicare Assignment	Y