Physician Compare National (NPI:1821031758)

HEALTHCARE PROVIDER: WALTER MAITLAND GRAHAM 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	1821031758
	Unique healthcare provider (clinician) ID assigned by NPPES
PECOS UID	0648464586
	Unique individual clinician ID assigned by PECOS
Professional Enrollment ID	I20101104000353
	Unique ID for the individual professional enrollment that is the source for the data in the observation
Provider Last Name	GRAHAM
	Individual professional last name
Provider First Name	WALTER
	Individual professional first name
Provider Middle Name	MAITLAND
	Individual professional middle name
Provider Gender	M
	The provider's gender if the provider is a person.

Medical School Information
Medical School Name	BAYLOR COLLEGE OF MEDICINE
	Individual professional's medical school
Graduation Year	1990
	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	1501 HILAND AVE
	Group Practice or individual's line 1 address
Line 2 Street Address	SUITE L2
	Group Practice or individual's line 2 address
City	BURLEY
	Group Practice or individual's city
State	ID
	Group Practice or individual's state
Zip Code	833182686
	Group Practice or individual's zip code (9 digits when available)
Phone Number	2086773034
	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	131326
	Medicare CCN of hospital where individual professional provides service 1
Hospital Affiliation LBN 1	CASSIA REGIONAL HOSPITAL
	Legal business name of hospital where individual professional provides service 1
Hospital Affiliation CCN 2	131319
	Medicare CCN of hospital where individual professional provides service 2
Hospital Affiliation LBN 2	MINIDOKA MEMORIAL HOSPITAL
	Legal business name of hospital where individual professional provides service 2
Hospital Affiliation CCN 3	130002
	Medicare CCN of hospital where individual professional provides service 3
Hospital Affiliation LBN 3	ST LUKES MAGIC VALLEY MEDICAL CENTER
	Legal business name of hospital where individual professional provides service 3
Professional Accepts Medicare Assignment	M