Physician Compare National (NPI:1841246279)

HEALTHCARE PROVIDER: ANTHONY MAISIN BUONCRISTIANI 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	1841246279
	Unique healthcare provider (clinician) ID assigned by NPPES
PECOS UID	7911906045
	Unique individual clinician ID assigned by PECOS
Professional Enrollment ID	I20061218000490
	Unique ID for the individual professional enrollment that is the source for the data in the observation
Provider Last Name	BUONCRISTIANI
	Individual professional last name
Provider First Name	ANTHONY
	Individual professional first name
Provider Middle Name	MAISIN
	Individual professional middle name
Provider Gender	M
	The provider's gender if the provider is a person.
Provider Credential Text	MD
	The abbreviations for professional degrees or credentials used or held by the provider, if the provider is an individual. Examples are MD, DDS, CSW, CNA, AA, NP, RNA, or PSY. These credential designations will not be verified by NPS.

Medical School Information
Medical School Name	UNIVERSITY OF SOUTHERN CALIFORNIA KECK SCHOOL OF MEDICINE
	Individual professional's medical school
Graduation Year	1995
	Individual professional's medical school graduation year
Primary Specialty	ORTHOPEDIC SURGERY
	Primary medical specialty reported by the individual professional in the selected enrollment
Secondary Specialty 1	SPORTS MEDICINE
	First secondary medical specialty reported by the individual professional in the selected enrollment
All Secondary Specialties	SPORTS MEDICINE
	All four secondary specialties reported by the individual professional in the selected enrollment, separated by commas

Practice Information
Line 1 Street Address	100 HOSPITAL DR
	Group Practice or individual's line 1 address
Line 2 Street Address	SUITE 107
	Group Practice or individual's line 2 address
City	KETCHUM
	Group Practice or individual's city
State	ID
	Group Practice or individual's state
Zip Code	83340
	Group Practice or individual's zip code (9 digits when available)

Hospital(s) Affiliation Information
Hospital Affiliation CCN 1	131323
	Medicare CCN of hospital where individual professional provides service 1
Hospital Affiliation LBN 1	ST LUKE'S WOOD RIVER MEDICAL CENTER
	Legal business name of hospital where individual professional provides service 1
Professional Accepts Medicare Assignment	Y