Physician Compare National (NPI:1023231651)

HEALTHCARE PROVIDER:

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

Individual Professional Information
NPI	1023231651
	Unique healthcare provider (clinician) ID assigned by NPPES
PECOS UID	0941340137
	Unique individual clinician ID assigned by PECOS
Professional Enrollment ID	I20091218000464
	Unique ID for the individual professional enrollment that is the source for the data in the observation
Provider Last Name	BOGERTY
	Individual professional last name
Provider First Name	SHARON
	Individual professional first name
Provider Middle Name	A
	Individual professional middle name
Provider Gender	F
	The provider's gender if the provider is a person.

Medical School Information
Medical School Name	STANFORD UNIVERSITY SCHOOL OF MEDICINE
	Individual professional's medical school
Graduation Year	1973
	Individual professional's medical school graduation year
Primary Specialty	THORACIC SURGERY
	Primary medical specialty reported by the individual professional in the selected enrollment
Secondary Specialty 1	CARDIAC SURGERY
	First secondary medical specialty reported by the individual professional in the selected enrollment
Secondary Specialty 2	VASCULAR SURGERY
	Second secondary medical specialty reported by the individual professional in the selected enrollment
All Secondary Specialties	CARDIAC SURGERY, VASCULAR SURGERY
	All four secondary specialties reported by the individual professional in the selected enrollment, separated by commas

Practice Information
Line 1 Street Address	105 N BASCOM AVE
	Group Practice or individual's line 1 address
Line 2 Street Address	SUITE 101B
	Group Practice or individual's line 2 address
City	SAN JOSE
	Group Practice or individual's city
State	CA
	Group Practice or individual's state
Zip Code	951281811
	Group Practice or individual's zip code (9 digits when available)

Hospital(s) Affiliation Information
Hospital Affiliation CCN 1	050038
	Medicare CCN of hospital where individual professional provides service 1
Hospital Affiliation LBN 1	SANTA CLARA VALLEY MEDICAL CENTER
	Legal business name of hospital where individual professional provides service 1
Professional Accepts Medicare Assignment	M