Physician Compare National (NPI:1932213139)

HEALTHCARE PROVIDER:

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

Individual Professional Information
NPI	1932213139
	Unique healthcare provider (clinician) ID assigned by NPPES
PECOS UID	4183725682
	Unique individual clinician ID assigned by PECOS
Professional Enrollment ID	I20090917000372
	Unique ID for the individual professional enrollment that is the source for the data in the observation
Provider Last Name	BROCKENBROUGH
	Individual professional last name
Provider First Name	JAMES
	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	HOWARD UNIVERSITY COLLEGE OF MEDICINE
	Individual professional's medical school
Graduation Year	1972
	Individual professional's medical school graduation year
Primary Specialty	THORACIC SURGERY
	Primary medical specialty reported by the individual professional in the selected enrollment
Secondary Specialty 1	GENERAL PRACTICE
	First secondary medical specialty reported by the individual professional in the selected enrollment
Secondary Specialty 2	GENERAL SURGERY
	Second secondary medical specialty reported by the individual professional in the selected enrollment
Secondary Specialty 3	GERIATRIC MEDICINE
	Third secondary medical specialty reported by the individual professional in the selected enrollment
Secondary Specialty 4	VASCULAR SURGERY
	Fourth secondary medical specialty reported by the individual professional in the selected enrollment
All Secondary Specialties	GENERAL PRACTICE, GENERAL SURGERY, GERIATRIC MEDICINE, VASCULAR SURGERY
	All four secondary specialties reported by the individual professional in the selected enrollment, separated by commas

Practice Information
Line 1 Street Address	804 WOLLARD BLVD
	Group Practice or individual's line 1 address
City	RICHMOND
	Group Practice or individual's city
State	MO
	Group Practice or individual's state
Zip Code	640852227
	Group Practice or individual's zip code (9 digits when available)

Hospital(s) Affiliation Information
Professional Accepts Medicare Assignment	Y