Physician Compare National (NPI:1043652290)

HEALTHCARE PROVIDER: PRERNA ALFA MALL DPM

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

Individual Professional Information
NPI	1043652290
	Unique healthcare provider (clinician) ID assigned by NPPES
PECOS UID	6507153731
	Unique individual clinician ID assigned by PECOS
Professional Enrollment ID	I20161003000235
	Unique ID for the individual professional enrollment that is the source for the data in the observation
Provider Last Name	MALL
	Individual professional last name
Provider First Name	PRERNA
	Individual professional first name
Provider Gender	F
	The provider's gender if the provider is a person.

Medical School Information
Medical School Name	BARRY UNIVERSITY SCHOOL OF PODIATRIC MEDICINE
	Individual professional's medical school
Graduation Year	2013
	Individual professional's medical school graduation year
Primary Specialty	PODIATRY
	Primary medical specialty reported by the individual professional in the selected enrollment

Practice Information
Line 1 Street Address	408 S 1ST ST
	Group Practice or individual's line 1 address
City	LAKE WALES
	Group Practice or individual's city
State	FL
	Group Practice or individual's state
Zip Code	338534146
	Group Practice or individual's zip code (9 digits when available)

Hospital(s) Affiliation Information
Hospital Affiliation CCN 1	100099
	Medicare CCN of hospital where individual professional provides service 1
Hospital Affiliation LBN 1	LAKE WALES MEDICAL CENTER
	Legal business name of hospital where individual professional provides service 1
Professional Accepts Medicare Assignment	Y