Physician Compare National (NPI:1881680353)

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	1881680353
	Unique healthcare provider (clinician) ID assigned by NPPES
PECOS UID	3779742663
	Unique individual clinician ID assigned by PECOS
Professional Enrollment ID	I20120313000385
	Unique ID for the individual professional enrollment that is the source for the data in the observation
Provider Last Name	NELLSCH
	Individual professional last name
Provider First Name	VERNER
	Individual professional first name
Provider Middle Name	O
	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 KANSAS SCHOOL OF MED (KC/WICH/SAL)
	Individual professional's medical school
Graduation Year	1978
	Individual professional's medical school graduation year
Primary Specialty	OBSTETRICS/GYNECOLOGY
	Primary medical specialty reported by the individual professional in the selected enrollment

Practice Information
Line 1 Street Address	400 BYPASS LN
	Group Practice or individual's line 1 address
Line 2 Street Address	SUITE 108
	Group Practice or individual's line 2 address
City	LIVINGSTON
	Group Practice or individual's city
State	TX
	Group Practice or individual's state
Zip Code	773517380
	Group Practice or individual's zip code (9 digits when available)
Phone Number	9363278844
	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	450395
	Medicare CCN of hospital where individual professional provides service 1
Hospital Affiliation LBN 1	MEMORIAL MEDICAL CENTER LIVINGSTON
	Legal business name of hospital where individual professional provides service 1
Professional Accepts Medicare Assignment	Y