Physician Compare National (NPI:1013200062)

HEALTHCARE PROVIDER: SHAHROZ KIDWAI 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	1013200062
	Unique healthcare provider (clinician) ID assigned by NPPES
PECOS UID	7618193871
	Unique individual clinician ID assigned by PECOS
Professional Enrollment ID	I20150121000151
	Unique ID for the individual professional enrollment that is the source for the data in the observation
Provider Last Name	KIDWAI
	Individual professional last name
Provider First Name	SHAHROZ
	Individual professional first 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	2011
	Individual professional's medical school graduation year
Primary Specialty	FAMILY MEDICINE
	Primary medical specialty reported by the individual professional in the selected enrollment

Practice Information
Organization Legal Name	CAMPION EMERGENCY PHYSICIANS PLLC
	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	5991886921
	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	7
	Total number of individual professionals affiliated with the Group Practice based on Group Practice PAC ID
Line 1 Street Address	400 W
	Group Practice or individual's line 1 address
Line 2 Street Address	SUITE 635
	Group Practice or individual's line 2 address
City	IRVING
	Group Practice or individual's city
State	TX
	Group Practice or individual's state
Zip Code	75063
	Group Practice or individual's zip code (9 digits when available)
Phone Number	9728684000
	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	670049
	Medicare CCN of hospital where individual professional provides service 1
Hospital Affiliation LBN 1	NORTH CENTRAL SURGICAL CENTER LLP
	Legal business name of hospital where individual professional provides service 1
Hospital Affiliation CCN 2	320021
	Medicare CCN of hospital where individual professional provides service 2
Hospital Affiliation LBN 2	PRESBYTERIAN HOSPITAL
	Legal business name of hospital where individual professional provides service 2
Hospital Affiliation CCN 3	450874
	Medicare CCN of hospital where individual professional provides service 3
Hospital Affiliation LBN 3	BAYLOR SURGICAL HOSPITAL AT LAS COLINAS
	Legal business name of hospital where individual professional provides service 3
Professional Accepts Medicare Assignment	Y