Physician Compare National (NPI:1023009297)

HEALTHCARE PROVIDER: DAVID R GOTHAM JR. 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	1023009297
	Unique healthcare provider (clinician) ID assigned by NPPES
PECOS UID	6002882719
	Unique individual clinician ID assigned by PECOS
Professional Enrollment ID	I20040903000534
	Unique ID for the individual professional enrollment that is the source for the data in the observation
Provider Last Name	GOTHAM
	Individual professional last name
Provider First Name	DAVID
	Individual professional first name
Provider Middle Name	R
	Individual professional middle name
Provider Name Suffix Text	JR.
	The name suffix of the provider if the provider is an individual. The name suffix is a ''generation-related'' suffix, such as Jr., Sr., II, III, IV, or V.
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	NEW YORK MEDICAL COLLEGE
	Individual professional's medical school
Graduation Year	1999
	Individual professional's medical school graduation year
Primary Specialty	ORTHOPEDIC SURGERY
	Primary medical specialty reported by the individual professional in the selected enrollment

Practice Information
Line 1 Street Address	2204 PLAZA DR
	Group Practice or individual's line 1 address
Line 2 Street Address	SUITE 120
	Group Practice or individual's line 2 address
City	ROCKLIN
	Group Practice or individual's city
State	CA
	Group Practice or individual's state
Zip Code	957654413
	Group Practice or individual's zip code (9 digits when available)

Hospital(s) Affiliation Information
Hospital Affiliation CCN 1	050309
	Medicare CCN of hospital where individual professional provides service 1
Hospital Affiliation LBN 1	SUTTER ROSEVILLE MEDICAL CENTER
	Legal business name of hospital where individual professional provides service 1
Hospital Affiliation CCN 2	050498
	Medicare CCN of hospital where individual professional provides service 2
Hospital Affiliation LBN 2	SUTTER AUBURN FAITH HOSPITAL
	Legal business name of hospital where individual professional provides service 2
Hospital Affiliation CCN 3	050150
	Medicare CCN of hospital where individual professional provides service 3
Hospital Affiliation LBN 3	SIERRA NEVADA MEMORIAL HOSPITAL
	Legal business name of hospital where individual professional provides service 3
Professional Accepts Medicare Assignment	Y