Physician Compare National (NPI:1003815887)

HEALTHCARE PROVIDER: MITCHELL ANDREW FOGEL M.D.

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

Individual Professional Information
NPI	1003815887
	Unique healthcare provider (clinician) ID assigned by NPPES
PECOS UID	3870480361
	Unique individual clinician ID assigned by PECOS
Professional Enrollment ID	I20171115001968
	Unique ID for the individual professional enrollment that is the source for the data in the observation
Provider Last Name	FOGEL
	Individual professional last name
Provider First Name	MITCHELL
	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	PERELMAN SCHOOL OF MED AT THE UNIVERSITY OF PENNSYLVANIA
	Individual professional's medical school
Graduation Year	1982
	Individual professional's medical school graduation year
Primary Specialty	NEPHROLOGY
	Primary medical specialty reported by the individual professional in the selected enrollment

Practice Information
Organization Legal Name	AMBOY MEDICAL PRACTICE PC
	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	2860538170
	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	109
	Total number of individual professionals affiliated with the Group Practice based on Group Practice PAC ID
Line 1 Street Address	355 BARD AVE
	Group Practice or individual's line 1 address
Marker of address line 2 suppression	Y
	Marker that address as reported may be incomplete
City	STATEN ISLAND
	Group Practice or individual's city
State	NY
	Group Practice or individual's state
Zip Code	103101664
	Group Practice or individual's zip code (9 digits when available)

Hospital(s) Affiliation Information
Hospital Affiliation CCN 1	330028
	Medicare CCN of hospital where individual professional provides service 1
Hospital Affiliation LBN 1	RICHMOND UNIVERSITY MEDICAL CENTER
	Legal business name of hospital where individual professional provides service 1
Professional Accepts Medicare Assignment	Y