Physician Compare National (NPI:1821035130)

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	1821035130
	Unique healthcare provider (clinician) ID assigned by NPPES
PECOS UID	9537227269
	Unique individual clinician ID assigned by PECOS
Professional Enrollment ID	I20120306000500
	Unique ID for the individual professional enrollment that is the source for the data in the observation
Provider Last Name	HARDIN
	Individual professional last name
Provider First Name	MARK
	Individual professional first name
Provider Middle Name	ALAN
	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	1982
	Individual professional's medical school graduation year
Primary Specialty	OTOLARYNGOLOGY
	Primary medical specialty reported by the individual professional in the selected enrollment

Practice Information
Line 1 Street Address	9301 N CENTRAL EXPRESSWAY
	Group Practice or individual's line 1 address
Line 2 Street Address	SUITE 560
	Group Practice or individual's line 2 address
City	DALLAS
	Group Practice or individual's city
State	TX
	Group Practice or individual's state
Zip Code	752310817
	Group Practice or individual's zip code (9 digits when available)

Hospital(s) Affiliation Information
Hospital Affiliation CCN 1	450422
	Medicare CCN of hospital where individual professional provides service 1
Hospital Affiliation LBN 1	BAYLOR MEDICAL CENTER AT UPTOWN
	Legal business name of hospital where individual professional provides service 1
Professional Accepts Medicare Assignment	M