Physician Compare National (NPI:1972587251)

HEALTHCARE PROVIDER: MARK A HENRY 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	1972587251
	Unique healthcare provider (clinician) ID assigned by NPPES
PECOS UID	7012094584
	Unique individual clinician ID assigned by PECOS
Professional Enrollment ID	I20100421000535
	Unique ID for the individual professional enrollment that is the source for the data in the observation
Provider Last Name	HENRY
	Individual professional last name
Provider First Name	MARK
	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	UNIVERSITY OF KENTUCKY COLLEGE OF MEDICINE
	Individual professional's medical school
Graduation Year	1986
	Individual professional's medical school graduation year
Primary Specialty	OPHTHALMOLOGY
	Primary medical specialty reported by the individual professional in the selected enrollment

Practice Information
Organization Legal Name	SOUTHERN KENTUCKY EYE CENTER, PSC
	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	4183701659
	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	2
	Total number of individual professionals affiliated with the Group Practice based on Group Practice PAC ID
Line 1 Street Address	120 TRADEPARK DR
	Group Practice or individual's line 1 address
Line 2 Street Address	SUITE A
	Group Practice or individual's line 2 address
City	SOMERSET
	Group Practice or individual's city
State	KY
	Group Practice or individual's state
Zip Code	425033454
	Group Practice or individual's zip code (9 digits when available)
Phone Number	6066797778797778
	Phone number is listed only when there is a single phone number available for the practice location address

Hospital(s) Affiliation Information
Hospital Affiliation CCN 1	180106
	Medicare CCN of hospital where individual professional provides service 1
Hospital Affiliation LBN 1	CLINTON COUNTY HOSPITAL, INC
	Legal business name of hospital where individual professional provides service 1
Hospital Affiliation CCN 2	181321
	Medicare CCN of hospital where individual professional provides service 2
Hospital Affiliation LBN 2	WAYNE COUNTY HOSPITAL
	Legal business name of hospital where individual professional provides service 2
Hospital Affiliation CCN 3	181330
	Medicare CCN of hospital where individual professional provides service 3
Hospital Affiliation LBN 3	RUSSELL COUNTY HOSPITAL
	Legal business name of hospital where individual professional provides service 3
Hospital Affiliation CCN 4	180132
	Medicare CCN of hospital where individual professional provides service 4
Hospital Affiliation LBN 4	LAKE CUMBERLAND REGIONAL HOSPITAL
	Legal business name of hospital where individual professional provides service 4
Professional Accepts Medicare Assignment	Y