Physician Compare National (NPI:1831484138)

HEALTHCARE PROVIDER: JOHN MICHAEL CLARK D.O.

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

Individual Professional Information
NPI	1831484138
	Unique healthcare provider (clinician) ID assigned by NPPES
PECOS UID	8022306133
	Unique individual clinician ID assigned by PECOS
Professional Enrollment ID	I20180709002034
	Unique ID for the individual professional enrollment that is the source for the data in the observation
Provider Last Name	CLARK
	Individual professional last name
Provider First Name	JOHN
	Individual professional first name
Provider Middle Name	MICHAEL
	Individual professional middle name
Provider Gender	M
	The provider's gender if the provider is a person.

Medical School Information
Medical School Name	PHILADELPHIA COLLEGE OF OSTEOPATHIC MEDICINE
	Individual professional's medical school
Graduation Year	2011
	Individual professional's medical school graduation year
Primary Specialty	CARDIOVASCULAR DISEASE (CARDIOLOGY)
	Primary medical specialty reported by the individual professional in the selected enrollment
Secondary Specialty 1	ADVANCED HEART FAILURE AND TRANSPLANT CARDIOLOGY
	First secondary medical specialty reported by the individual professional in the selected enrollment
All Secondary Specialties	ADVANCED HEART FAILURE AND TRANSPLANT CARDIOLOGY
	All four secondary specialties reported by the individual professional in the selected enrollment, separated by commas

Practice Information
Organization Legal Name	MAIN LINE HEALTHCARE
	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	1951215201
	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	620
	Total number of individual professionals affiliated with the Group Practice based on Group Practice PAC ID
Line 1 Street Address	100 E LANCASTER AVE
	Group Practice or individual's line 1 address
Marker of address line 2 suppression	Y
	Marker that address as reported may be incomplete
City	WYNEWOOD
	Group Practice or individual's city
State	PA
	Group Practice or individual's state
Zip Code	190963450
	Group Practice or individual's zip code (9 digits when available)

Hospital(s) Affiliation Information
Hospital Affiliation CCN 1	390195
	Medicare CCN of hospital where individual professional provides service 1
Hospital Affiliation LBN 1	MAIN LINE HOSPITAL LANKENAU
	Legal business name of hospital where individual professional provides service 1
Hospital Affiliation CCN 2	390153
	Medicare CCN of hospital where individual professional provides service 2
Hospital Affiliation LBN 2	PAOLI HOSPITAL
	Legal business name of hospital where individual professional provides service 2
Professional Accepts Medicare Assignment	Y