Physician Compare National (NPI:1912106279)

HEALTHCARE PROVIDER: WILLIAM J HABERLIN II 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	1912106279
	Unique healthcare provider (clinician) ID assigned by NPPES
PECOS UID	9234376310
	Unique individual clinician ID assigned by PECOS
Professional Enrollment ID	I20140723000834
	Unique ID for the individual professional enrollment that is the source for the data in the observation
Provider Last Name	HABERLIN
	Individual professional last name
Provider First Name	WILLIAM
	Individual professional first name
Provider Middle Name	J
	Individual professional middle name
Provider Name Suffix Text	II
	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	2007
	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	TRAUMA SURGICAL ASSOC
	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	1951472695
	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	5
	Total number of individual professionals affiliated with the Group Practice based on Group Practice PAC ID
Line 1 Street Address	6507 DEER POINTE DR
	Group Practice or individual's line 1 address
City	SALISBURY
	Group Practice or individual's city
State	MD
	Group Practice or individual's state
Zip Code	218041667
	Group Practice or individual's zip code (9 digits when available)

Hospital(s) Affiliation Information
Hospital Affiliation CCN 1	210019
	Medicare CCN of hospital where individual professional provides service 1
Hospital Affiliation LBN 1	PENINSULA REGIONAL MEDICAL CENTER
	Legal business name of hospital where individual professional provides service 1
Hospital Affiliation CCN 2	210061
	Medicare CCN of hospital where individual professional provides service 2
Hospital Affiliation LBN 2	ATLANTIC GENERAL HOSPITAL
	Legal business name of hospital where individual professional provides service 2
Professional Accepts Medicare Assignment	Y