Physician Compare National (NPI:1821104605)

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	1821104605
	Unique healthcare provider (clinician) ID assigned by NPPES
PECOS UID	3274662457
	Unique individual clinician ID assigned by PECOS
Professional Enrollment ID	I20100526000639
	Unique ID for the individual professional enrollment that is the source for the data in the observation
Provider Last Name	SKINNER
	Individual professional last name
Provider First Name	WILLIAM
	Individual professional first name
Provider Gender	M
	The provider's gender if the provider is a person.

Medical School Information
Medical School Name	UNIVERSITY OF SOUTHERN CALIFORNIA KECK SCHOOL OF MEDICINE
	Individual professional's medical school
Graduation Year	1975
	Individual professional's medical school graduation year
Primary Specialty	INTERNAL MEDICINE
	Primary medical specialty reported by the individual professional in the selected enrollment
Secondary Specialty 1	CARDIOVASCULAR DISEASE (CARDIOLOGY)
	First secondary medical specialty reported by the individual professional in the selected enrollment
All Secondary Specialties	CARDIOVASCULAR DISEASE (CARDIOLOGY)
	All four secondary specialties reported by the individual professional in the selected enrollment, separated by commas

Practice Information
Line 1 Street Address	2001 SANTA MONICA BLVD
	Group Practice or individual's line 1 address
Line 2 Street Address	1260W
	Group Practice or individual's line 2 address
City	SANTA MONICA
	Group Practice or individual's city
State	CA
	Group Practice or individual's state
Zip Code	904042110
	Group Practice or individual's zip code (9 digits when available)
Phone Number	3108291711
	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	050290
	Medicare CCN of hospital where individual professional provides service 1
Hospital Affiliation LBN 1	PROVIDENCE SAINT JOHN'S HEALTH CENTER
	Legal business name of hospital where individual professional provides service 1
Professional Accepts Medicare Assignment	Y