Physician Compare National (NPI:1861432197)

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	1861432197
	Unique healthcare provider (clinician) ID assigned by NPPES
PECOS UID	6204869654
	Unique individual clinician ID assigned by PECOS
Professional Enrollment ID	I20170607001356
	Unique ID for the individual professional enrollment that is the source for the data in the observation
Provider Last Name	FORSYTHE
	Individual professional last name
Provider First Name	MARKUS
	Individual professional first name
Provider Middle Name	L
	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	OREGON HEALTH SCIENCES UNIVERSITY SCHOOL OF MEDICINE
	Individual professional's medical school
Graduation Year	1993
	Individual professional's medical school graduation year
Primary Specialty	EMERGENCY MEDICINE
	Primary medical specialty reported by the individual professional in the selected enrollment

Practice Information
Organization Legal Name	HEALOGICS SPECIALTY PHYSICIANS OF OREGON 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	1254637846
	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	10
	Total number of individual professionals affiliated with the Group Practice based on Group Practice PAC ID
Line 1 Street Address	392 NE NORTON LN
	Group Practice or individual's line 1 address
City	MCMINNVILLE
	Group Practice or individual's city
State	OR
	Group Practice or individual's state
Zip Code	971288481
	Group Practice or individual's zip code (9 digits when available)
Phone Number	5034725749
	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	500050
	Medicare CCN of hospital where individual professional provides service 1
Hospital Affiliation LBN 1	PEACEHEALTH SOUTHWEST MEDICAL CENTER
	Legal business name of hospital where individual professional provides service 1
Hospital Affiliation CCN 2	500058
	Medicare CCN of hospital where individual professional provides service 2
Hospital Affiliation LBN 2	KADLEC REGIONAL MEDICAL CENTER
	Legal business name of hospital where individual professional provides service 2
Hospital Affiliation CCN 3	380037
	Medicare CCN of hospital where individual professional provides service 3
Hospital Affiliation LBN 3	PROVIDENCE NEWBERG MEDICAL CENTER
	Legal business name of hospital where individual professional provides service 3
Hospital Affiliation CCN 4	380071
	Medicare CCN of hospital where individual professional provides service 4
Hospital Affiliation LBN 4	WILLAMETTE VALLEY MEDICAL CENTER
	Legal business name of hospital where individual professional provides service 4
Professional Accepts Medicare Assignment	Y