Physician Compare National (NPI:1982603452)

HEALTHCARE PROVIDER: FOREST REGINALD CONLEY DO

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

Individual Professional Information
NPI	1982603452
	Unique healthcare provider (clinician) ID assigned by NPPES
PECOS UID	9032012844
	Unique individual clinician ID assigned by PECOS
Professional Enrollment ID	I20040129000554
	Unique ID for the individual professional enrollment that is the source for the data in the observation
Provider Last Name	CONLEY
	Individual professional last name
Provider First Name	FOREST
	Individual professional first name
Provider Middle Name	R
	Individual professional middle name
Provider Gender	M
	The provider's gender if the provider is a person.
Provider Credential Text	DO
	The abbreviations for professional degrees or credentials used or held by the provider, if the provider is an individual. Examples are MD, DDS, CSW, CNA, AA, NP, RNA, or PSY. These credential designations will not be verified by NPS.

Medical School Information
Medical School Name	AT STILL UNIVERSITY OF HEALTH SCIENCES, COLLEGE OF OSTEO MED, KIRKSVILLE
	Individual professional's medical school
Graduation Year	1976
	Individual professional's medical school graduation year
Primary Specialty	GENERAL PRACTICE
	Primary medical specialty reported by the individual professional in the selected enrollment

Practice Information
Organization Legal Name	CONLEY CLINIC LLC
	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	0547283459
	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	1145 S MORLEY ST
	Group Practice or individual's line 1 address
City	MOBERLY
	Group Practice or individual's city
State	MO
	Group Practice or individual's state
Zip Code	652701948
	Group Practice or individual's zip code (9 digits when available)
Phone Number	6602633185
	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	260068
	Medicare CCN of hospital where individual professional provides service 1
Hospital Affiliation LBN 1	BOONE HOSPITAL CENTER
	Legal business name of hospital where individual professional provides service 1
Hospital Affiliation CCN 2	261313
	Medicare CCN of hospital where individual professional provides service 2
Hospital Affiliation LBN 2	MACON COUNTY SAMARITAN MEMORIAL HOSPITAL
	Legal business name of hospital where individual professional provides service 2
Hospital Affiliation CCN 3	260074
	Medicare CCN of hospital where individual professional provides service 3
Hospital Affiliation LBN 3	MOBERLY REGIONAL MEDICAL CENTER
	Legal business name of hospital where individual professional provides service 3
Hospital Affiliation CCN 4	260142
	Medicare CCN of hospital where individual professional provides service 4
Hospital Affiliation LBN 4	FITZGIBBON MEMORIAL HOSPITAL
	Legal business name of hospital where individual professional provides service 4
Professional Accepts Medicare Assignment	Y