Physician Compare National (NPI:1861485617)

HEALTHCARE PROVIDER: LARRY ALLEN SISSON 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	1861485617
	Unique healthcare provider (clinician) ID assigned by NPPES
PECOS UID	5395833305
	Unique individual clinician ID assigned by PECOS
Professional Enrollment ID	I20090115000352
	Unique ID for the individual professional enrollment that is the source for the data in the observation
Provider Last Name	SISSON
	Individual professional last name
Provider First Name	LARRY
	Individual professional first name
Provider Middle Name	ALLEN
	Individual professional middle name
Provider Gender	M
	The provider's gender if the provider is a person.

Medical School Information
Medical School Name	UNIVERSITY OF WISCONSIN SCHOOL OF MEDICINE
	Individual professional's medical school
Graduation Year	1982
	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	NORTH COUNTRY HOSPITAL AND HEALTH CENTER INC
	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	9739073479
	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	45
	Total number of individual professionals affiliated with the Group Practice based on Group Practice PAC ID
Line 1 Street Address	189 PROUTY DR
	Group Practice or individual's line 1 address
City	NEWPORT
	Group Practice or individual's city
State	VT
	Group Practice or individual's state
Zip Code	058559326
	Group Practice or individual's zip code (9 digits when available)
Phone Number	8023343580
	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	471304
	Medicare CCN of hospital where individual professional provides service 1
Hospital Affiliation LBN 1	NORTH COUNTRY HOSPITAL AND HEALTH CENTER
	Legal business name of hospital where individual professional provides service 1
Hospital Affiliation CCN 2	301300
	Medicare CCN of hospital where individual professional provides service 2
Hospital Affiliation LBN 2	UPPER CONNECTICUT VALLEY HOSPITAL
	Legal business name of hospital where individual professional provides service 2
Professional Accepts Medicare Assignment	Y