*Information contained in this database is either primary-source verified or self-reported by the facility, and is validated every 36 months during recredentialing (with the exception of Medical group affiliation, which is determined by contractual arrangement).
Provider ID
Provider Name
Type Code
TIN#
Medicare ID
Svc. Location
NPI
Billing Name
City
State
Medicaid ID
Zip Code - Range
In Network
Line of Business
 
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