Physician Compare National (NPI:1831187269)

HEALTHCARE PROVIDER: THEODORE C TUCKER MD

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

Individual Professional Information
NPI	1831187269
	Unique healthcare provider (clinician) ID assigned by NPPES
PECOS UID	5294759098
	Unique individual clinician ID assigned by PECOS
Professional Enrollment ID	I20171130003140
	Unique ID for the individual professional enrollment that is the source for the data in the observation
Provider Last Name	TUCKER
	Individual professional last name
Provider First Name	THEODORE
	Individual professional first name
Provider Gender	M
	The provider's gender if the provider is a person.

Medical School Information
Medical School Name	UNIV OF NEBRASKA MEDICAL CENTER, COL OF DENTISTRY
	Individual professional's medical school
Graduation Year	2000
	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
Organization Legal Name	ATHENS PHYSICIANS PRACTICE LLC
	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	2163490319
	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	11
	Total number of individual professionals affiliated with the Group Practice based on Group Practice PAC ID
Line 1 Street Address	711 COOK DR
	Group Practice or individual's line 1 address
Marker of address line 2 suppression	Y
	Marker that address as reported may be incomplete
City	ATHENS
	Group Practice or individual's city
State	TN
	Group Practice or individual's state
Zip Code	373033400
	Group Practice or individual's zip code (9 digits when available)
Phone Number	4237447585
	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	440068
	Medicare CCN of hospital where individual professional provides service 1
Hospital Affiliation LBN 1	STARR REGIONAL MEDICAL CENTER ATHENS
	Legal business name of hospital where individual professional provides service 1
Professional Accepts Medicare Assignment	Y