Physician Compare National (NPI:1053334177)

HEALTHCARE PROVIDER: SHAHROKH MANSOORI MD

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

Individual Professional Information
NPI	1053334177
	Unique healthcare provider (clinician) ID assigned by NPPES
PECOS UID	1951290162
	Unique individual clinician ID assigned by PECOS
Professional Enrollment ID	I20040316000112
	Unique ID for the individual professional enrollment that is the source for the data in the observation
Provider Last Name	MANSOORI
	Individual professional last name
Provider First Name	SHAHROKH
	Individual professional first name
Provider Middle Name	H
	Individual professional middle name
Provider Gender	M
	The provider's gender if the provider is a person.
Provider Credential Text	MD
	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	OTHER
	Individual professional's medical school
Graduation Year	1967
	Individual professional's medical school graduation year
Primary Specialty	THORACIC SURGERY
	Primary medical specialty reported by the individual professional in the selected enrollment

Practice Information
Line 1 Street Address	135 BARCLAY CIR
	Group Practice or individual's line 1 address
Line 2 Street Address	SUITE 109
	Group Practice or individual's line 2 address
City	ROCHESTER HILLS
	Group Practice or individual's city
State	MI
	Group Practice or individual's state
Zip Code	483074599
	Group Practice or individual's zip code (9 digits when available)

Hospital(s) Affiliation Information
Hospital Affiliation CCN 1	230254
	Medicare CCN of hospital where individual professional provides service 1
Hospital Affiliation LBN 1	CRITTENTON HOSPITAL MEDICAL CENTER
	Legal business name of hospital where individual professional provides service 1
Professional Accepts Medicare Assignment	Y