Physician Compare National (NPI:1891706875)

HEALTHCARE PROVIDER: TERRY E HICKS WOODBECK 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	1891706875
	Unique healthcare provider (clinician) ID assigned by NPPES
PECOS UID	5991734188
	Unique individual clinician ID assigned by PECOS
Professional Enrollment ID	I20050808001090
	Unique ID for the individual professional enrollment that is the source for the data in the observation
Provider Last Name	WOODBECK
	Individual professional last name
Provider First Name	TERRY
	Individual professional first name
Provider Middle Name	HICKS
	Individual professional middle name
Provider Gender	F
	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	UNIVERSITY OF ARIZONA COLLEGE OF MEDICINE
	Individual professional's medical school
Graduation Year	1995
	Individual professional's medical school graduation year
Primary Specialty	INTERNAL MEDICINE
	Primary medical specialty reported by the individual professional in the selected enrollment

Practice Information
Organization Legal Name	VERSATILE MEDICINE 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	3274597133
	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	13055 W MCDOWELL RD
	Group Practice or individual's line 1 address
Line 2 Street Address	SUITE E106
	Group Practice or individual's line 2 address
City	AVONDALE
	Group Practice or individual's city
State	AZ
	Group Practice or individual's state
Zip Code	853926457
	Group Practice or individual's zip code (9 digits when available)
Phone Number	6239758400
	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	030093
	Medicare CCN of hospital where individual professional provides service 1
Hospital Affiliation LBN 1	BANNER DEL E. WEBB MEDICAL CENTER
	Legal business name of hospital where individual professional provides service 1
Professional Accepts Medicare Assignment	Y