Physician Compare National (NPI:1881787547)

HEALTHCARE PROVIDER: EDWARD J OTTENHEIMER III 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	1881787547
	Unique healthcare provider (clinician) ID assigned by NPPES
PECOS UID	3577631761
	Unique individual clinician ID assigned by PECOS
Professional Enrollment ID	I20100204000418
	Unique ID for the individual professional enrollment that is the source for the data in the observation
Provider Last Name	OTTENHEIMER
	Individual professional last name
Provider First Name	EDWARD
	Individual professional first name
Provider Middle Name	J
	Individual professional middle name
Provider Name Suffix Text	III
	The name suffix of the provider if the provider is an individual. The name suffix is a ''generation-related'' suffix, such as Jr., Sr., II, III, IV, or V.
Provider Gender	M
	The provider's gender if the provider is a person.

Medical School Information
Medical School Name	OTHER
	Individual professional's medical school
Graduation Year	1982
	Individual professional's medical school graduation year
Primary Specialty	HEMATOLOGY/ONCOLOGY
	Primary medical specialty reported by the individual professional in the selected enrollment
Secondary Specialty 1	INTERNAL MEDICINE
	First secondary medical specialty reported by the individual professional in the selected enrollment
All Secondary Specialties	INTERNAL MEDICINE
	All four secondary specialties reported by the individual professional in the selected enrollment, separated by commas

Practice Information
Line 1 Street Address	1813 W HARVARD AVE
	Group Practice or individual's line 1 address
Line 2 Street Address	SUITE 436
	Group Practice or individual's line 2 address
City	ROSEBURG
	Group Practice or individual's city
State	OR
	Group Practice or individual's state
Zip Code	974718705
	Group Practice or individual's zip code (9 digits when available)

Hospital(s) Affiliation Information
Hospital Affiliation CCN 1	380027
	Medicare CCN of hospital where individual professional provides service 1
Hospital Affiliation LBN 1	MERCY MEDICAL CENTER
	Legal business name of hospital where individual professional provides service 1
Professional Accepts Medicare Assignment	Y