Physician Compare National (NPI:1982866935)

HEALTHCARE PROVIDER: TRACY T MACK 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	1982866935
	Unique healthcare provider (clinician) ID assigned by NPPES
PECOS UID	0244415388
	Unique individual clinician ID assigned by PECOS
Professional Enrollment ID	I20170109000629
	Unique ID for the individual professional enrollment that is the source for the data in the observation
Provider Last Name	MACK
	Individual professional last name
Provider First Name	TRACY
	Individual professional first name
Provider Middle Name	T.
	Individual professional middle name
Provider Gender	M
	The provider's gender if the provider is a person.

Medical School Information
Medical School Name	OTHER
	Individual professional's medical school
Graduation Year	2007
	Individual professional's medical school graduation year
Primary Specialty	EMERGENCY MEDICINE
	Primary medical specialty reported by the individual professional in the selected enrollment

Practice Information
Organization Legal Name	NES LOUISIANA INC
	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	5496651002
	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	14
	Total number of individual professionals affiliated with the Group Practice based on Group Practice PAC ID
Line 1 Street Address	501 KEYSER AVE
	Group Practice or individual's line 1 address
City	NATCHITOCHES
	Group Practice or individual's city
State	LA
	Group Practice or individual's state
Zip Code	714576018
	Group Practice or individual's zip code (9 digits when available)
Phone Number	3182144200
	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	361320
	Medicare CCN of hospital where individual professional provides service 1
Hospital Affiliation LBN 1	HOLZER MEDICAL CENTER JACKSON
	Legal business name of hospital where individual professional provides service 1
Hospital Affiliation CCN 2	190007
	Medicare CCN of hospital where individual professional provides service 2
Hospital Affiliation LBN 2	NATCHITOCHES REGIONAL MEDICAL CENTER
	Legal business name of hospital where individual professional provides service 2
Hospital Affiliation CCN 3	070011
	Medicare CCN of hospital where individual professional provides service 3
Hospital Affiliation LBN 3	CHARLOTTE HUNGERFORD HOSPITAL
	Legal business name of hospital where individual professional provides service 3
Professional Accepts Medicare Assignment	Y