Physician Compare National (NPI:1912110230)

HEALTHCARE PROVIDER: MATHESON ADAMS HARRIS M.D.

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

Individual Professional Information
NPI	1912110230
	Unique healthcare provider (clinician) ID assigned by NPPES
PECOS UID	0941356976
	Unique individual clinician ID assigned by PECOS
Professional Enrollment ID	I20110922000339
	Unique ID for the individual professional enrollment that is the source for the data in the observation
Provider Last Name	HARRIS
	Individual professional last name
Provider First Name	MATHESON
	Individual professional first name
Provider Middle Name	A
	Individual professional middle name
Provider Gender	M
	The provider's gender if the provider is a person.

Medical School Information
Medical School Name	PENNSYLVANIA STATE UNIVERSITY COLLEGE OF MEDICINE
	Individual professional's medical school
Graduation Year	2005
	Individual professional's medical school graduation year
Primary Specialty	OPHTHALMOLOGY
	Primary medical specialty reported by the individual professional in the selected enrollment

Practice Information
Line 1 Street Address	4400 S 700
	Group Practice or individual's line 1 address
Line 2 Street Address	SUITE 130
	Group Practice or individual's line 2 address
City	SALT LAKE CITY
	Group Practice or individual's city
State	UT
	Group Practice or individual's state
Zip Code	841073053
	Group Practice or individual's zip code (9 digits when available)

Hospital(s) Affiliation Information
Hospital Affiliation CCN 1	460047
	Medicare CCN of hospital where individual professional provides service 1
Hospital Affiliation LBN 1	ST MARK'S HOSPITAL
	Legal business name of hospital where individual professional provides service 1
Professional Accepts Medicare Assignment	Y