Physician Compare National (NPI:1053402610)

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	1053402610
	Unique healthcare provider (clinician) ID assigned by NPPES
PECOS UID	7012006463
	Unique individual clinician ID assigned by PECOS
Professional Enrollment ID	I20080227000548
	Unique ID for the individual professional enrollment that is the source for the data in the observation
Provider Last Name	RAHMAN
	Individual professional last name
Provider First Name	MAHFUZUR
	Individual professional first name
Provider Gender	M
	The provider's gender if the provider is a person.

Medical School Information
Medical School Name	OTHER
	Individual professional's medical school
Graduation Year	1970
	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	6890 ELMORE RD
	Group Practice or individual's line 1 address
Line 2 Street Address	SUITE 2
	Group Practice or individual's line 2 address
City	SOUTHAVEN
	Group Practice or individual's city
State	MS
	Group Practice or individual's state
Zip Code	386719673
	Group Practice or individual's zip code (9 digits when available)
Phone Number	6623491750
	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	250141
	Medicare CCN of hospital where individual professional provides service 1
Hospital Affiliation LBN 1	BAPTIST MEMORIAL HOSPITAL DESOTO
	Legal business name of hospital where individual professional provides service 1
Professional Accepts Medicare Assignment	Y