Physician Compare National (NPI:1962897041)

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	1962897041
	Unique healthcare provider (clinician) ID assigned by NPPES
PECOS UID	1951639723
	Unique individual clinician ID assigned by PECOS
Professional Enrollment ID	I20190819002004
	Unique ID for the individual professional enrollment that is the source for the data in the observation
Provider Last Name	MCLANE
	Individual professional last name
Provider First Name	LISA
	Individual professional first name
Provider Middle Name	HOLLOWAY
	Individual professional middle name
Provider Gender	F
	The provider's gender if the provider is a person.

Medical School Information
Medical School Name	COLLEGE OF OSTEO MED OF THE PACIFIC AT POMONA
	Individual professional's medical school
Graduation Year	2016
	Individual professional's medical school graduation year
Primary Specialty	FAMILY MEDICINE
	Primary medical specialty reported by the individual professional in the selected enrollment

Practice Information
Line 1 Street Address	10 MEDICAL CTR BLVD
	Group Practice or individual's line 1 address
City	LUFKIN
	Group Practice or individual's city
State	TX
	Group Practice or individual's state
Zip Code	759043173
	Group Practice or individual's zip code (9 digits when available)

Hospital(s) Affiliation Information
Hospital Affiliation CCN 1	450484
	Medicare CCN of hospital where individual professional provides service 1
Hospital Affiliation LBN 1	WOODLAND HEIGHTS MEDICAL CENTER
	Legal business name of hospital where individual professional provides service 1
Hospital Affiliation CCN 2	450211
	Medicare CCN of hospital where individual professional provides service 2
Hospital Affiliation LBN 2	CHI ST LUKES HEALTH MEMORIAL LUFKIN
	Legal business name of hospital where individual professional provides service 2
Professional Accepts Medicare Assignment	Y