Physician Compare National (NPI:1841343514)

HEALTHCARE PROVIDER: THOMAS WIXTED 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	1841343514
	Unique healthcare provider (clinician) ID assigned by NPPES
PECOS UID	0941347140
	Unique individual clinician ID assigned by PECOS
Professional Enrollment ID	I20091020000769
	Unique ID for the individual professional enrollment that is the source for the data in the observation
Provider Last Name	WIXTED
	Individual professional last name
Provider First Name	THOMAS
	Individual professional first name
Provider Middle Name	A
	Individual professional middle name
Provider Gender	M
	The provider's gender if the provider is a person.

Medical School Information
Medical School Name	JEFFERSON MEDICAL COLLEGE OF THOMAS JEFFERSON UNIVERSITY
	Individual professional's medical school
Graduation Year	2002
	Individual professional's medical school graduation year
Primary Specialty	GENERAL SURGERY
	Primary medical specialty reported by the individual professional in the selected enrollment

Practice Information
Organization Legal Name	KITSAP GENERAL SURGERY PLLC
	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	9830199553
	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	3
	Total number of individual professionals affiliated with the Group Practice based on Group Practice PAC ID
Line 1 Street Address	9927 MICKELBERRY RD NW
	Group Practice or individual's line 1 address
Line 2 Street Address	SUITE 121
	Group Practice or individual's line 2 address
City	SILVERDALE
	Group Practice or individual's city
State	WA
	Group Practice or individual's state
Zip Code	983837861
	Group Practice or individual's zip code (9 digits when available)
Phone Number	3606131335
	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	500039
	Medicare CCN of hospital where individual professional provides service 1
Hospital Affiliation LBN 1	HARRISON MEDICAL CENTER
	Legal business name of hospital where individual professional provides service 1
Professional Accepts Medicare Assignment	Y