Medical School Information |
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Medical School Name
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OTHER
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Individual professional's medical school
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Graduation Year
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1990
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Individual professional's medical school graduation year
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Primary Specialty
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GENERAL PRACTICE
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Primary medical specialty reported by the individual professional in the selected enrollment
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Secondary Specialty 1
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GERIATRIC MEDICINE
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First secondary medical specialty reported by the individual professional in the selected enrollment
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Secondary Specialty 2
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HOSPICE/PALLIATIVE CARE
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Second secondary medical specialty reported by the individual professional in the selected enrollment
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Secondary Specialty 3
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INTERNAL MEDICINE
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Third secondary medical specialty reported by the individual professional in the selected enrollment
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All Secondary Specialties
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GERIATRIC MEDICINE, HOSPICE/PALLIATIVE CARE, INTERNAL MEDICINE
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All four secondary specialties reported by the individual professional in the selected enrollment, separated by commas
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Hospital(s) Affiliation Information |
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Hospital Affiliation CCN 1
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220108
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Medicare CCN of hospital where individual professional provides service 1
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Hospital Affiliation LBN 1
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BETH ISRAEL DEACONESS HOSPITAL - MILTON
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Legal business name of hospital where individual professional provides service 1
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Hospital Affiliation CCN 2
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220100
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Medicare CCN of hospital where individual professional provides service 2
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Hospital Affiliation LBN 2
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SOUTH SHORE HOSPITAL
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Legal business name of hospital where individual professional provides service 2
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Hospital Affiliation CCN 3
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220060
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Medicare CCN of hospital where individual professional provides service 3
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Hospital Affiliation LBN 3
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BETH ISRAEL DEACONESS HOSPITAL PLYMOUTH
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Legal business name of hospital where individual professional provides service 3
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Hospital Affiliation CCN 4
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220110
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Medicare CCN of hospital where individual professional provides service 4
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Hospital Affiliation LBN 4
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BRIGHAM AND WOMEN'S HOSPITAL
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Legal business name of hospital where individual professional provides service 4
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Hospital Affiliation CCN 5
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220052
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Medicare CCN of hospital where individual professional provides service 5
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Hospital Affiliation LBN 5
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SIGNATURE HEALTHCARE BROCKTON HOSPITAL
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Legal business name of hospital where individual professional provides service 5
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Professional Accepts Medicare Assignment
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Y
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