Physician Compare National (NPI:1891716478)

HEALTHCARE PROVIDER: TIMOTHY M MOONEY DPM

Physician Compare National contains general information about individual eligible professionals (EPs) such as demographic information and Medicare quality program participation.

Individual Professional Information
NPI	1891716478
	Unique healthcare provider (clinician) ID assigned by NPPES
PECOS UID	2961433685
	Unique individual clinician ID assigned by PECOS
Professional Enrollment ID	I20050824000188
	Unique ID for the individual professional enrollment that is the source for the data in the observation
Provider Last Name	MOONEY
	Individual professional last name
Provider First Name	TIMOTHY
	Individual professional first name
Provider Middle Name	M
	Individual professional middle name
Provider Gender	M
	The provider's gender if the provider is a person.
Provider Credential Text	DPM
	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	WILLIAM M. SCHOLL COLLEGE OF PODIATRIC MEDICINE
	Individual professional's medical school
Graduation Year	1998
	Individual professional's medical school graduation year
Primary Specialty	PODIATRY
	Primary medical specialty reported by the individual professional in the selected enrollment

Practice Information
Organization Legal Name	NORTHERN NEVADA MEDICAL GROUP, 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	7214093020
	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	29
	Total number of individual professionals affiliated with the Group Practice based on Group Practice PAC ID
Line 1 Street Address	1020 NEW RIVER PKWY
	Group Practice or individual's line 1 address
Line 2 Street Address	SUITE 301
	Group Practice or individual's line 2 address
City	FALLON
	Group Practice or individual's city
State	NV
	Group Practice or individual's state
Zip Code	894067811
	Group Practice or individual's zip code (9 digits when available)
Phone Number	7754282150
	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	290032
	Medicare CCN of hospital where individual professional provides service 1
Hospital Affiliation LBN 1	NORTHERN NEVADA MEDICAL CENTER
	Legal business name of hospital where individual professional provides service 1
Hospital Affiliation CCN 2	291313
	Medicare CCN of hospital where individual professional provides service 2
Hospital Affiliation LBN 2	BANNER CHURCHILL COMMUNITY HOSPITAL
	Legal business name of hospital where individual professional provides service 2
Professional Accepts Medicare Assignment	Y