Physician Compare National (NPI:1023129491)

HEALTHCARE PROVIDER: JOHN JEFFERYS BANDOLA 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	1023129491
	Unique healthcare provider (clinician) ID assigned by NPPES
PECOS UID	6204961733
	Unique individual clinician ID assigned by PECOS
Professional Enrollment ID	I20100323000035
	Unique ID for the individual professional enrollment that is the source for the data in the observation
Provider Last Name	BANDOLA
	Individual professional last name
Provider First Name	JOHN
	Individual professional first name
Provider Middle Name	JEFFREYS
	Individual professional middle name
Provider Gender	M
	The provider's gender if the provider is a person.

Medical School Information
Medical School Name	GEORGE WASHINGTON UNIVERSITY SCHOOL OF MEDICINE
	Individual professional's medical school
Graduation Year	1978
	Individual professional's medical school graduation year
Primary Specialty	INTERNAL MEDICINE
	Primary medical specialty reported by the individual professional in the selected enrollment

Practice Information
Line 1 Street Address	70 KENYON AVE
	Group Practice or individual's line 1 address
Line 2 Street Address	UNIT 211
	Group Practice or individual's line 2 address
City	WAKEFIELD
	Group Practice or individual's city
State	RI
	Group Practice or individual's state
Zip Code	028794241
	Group Practice or individual's zip code (9 digits when available)
Phone Number	4107895843
	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	410008
	Medicare CCN of hospital where individual professional provides service 1
Hospital Affiliation LBN 1	SOUTH COUNTY HOSPITAL INC
	Legal business name of hospital where individual professional provides service 1
Hospital Affiliation CCN 2	410012
	Medicare CCN of hospital where individual professional provides service 2
Hospital Affiliation LBN 2	THE MIRIAM HOSPITAL
	Legal business name of hospital where individual professional provides service 2
Hospital Affiliation CCN 3	410007
	Medicare CCN of hospital where individual professional provides service 3
Hospital Affiliation LBN 3	RHODE ISLAND HOSPITAL
	Legal business name of hospital where individual professional provides service 3
Professional Accepts Medicare Assignment	M