Physician Compare National (NPI:1053601583)

HEALTHCARE PROVIDER: OUSSAMA BOUNDAOUI 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	1053601583
	Unique healthcare provider (clinician) ID assigned by NPPES
PECOS UID	1456653948
	Unique individual clinician ID assigned by PECOS
Professional Enrollment ID	I20160722000010
	Unique ID for the individual professional enrollment that is the source for the data in the observation
Provider Last Name	BOUNDAOUI
	Individual professional last name
Provider First Name	OUSSAMA
	Individual professional first name
Provider Gender	M
	The provider's gender if the provider is a person.

Medical School Information
Medical School Name	RUSH MEDICAL COLLEGE OF RUSH UNIVERSITY
	Individual professional's medical school
Graduation Year	2010
	Individual professional's medical school graduation year
Primary Specialty	OPHTHALMOLOGY
	Primary medical specialty reported by the individual professional in the selected enrollment

Practice Information
Organization Legal Name	THE VISION INSTITUTE OF ILLINOIS INC
	Legal name of the Group Practice that the individual professional works with- will be blank if the address is not linked to a Group Practice
Group Practice PAC ID	0446476097
	Unique Group Practice ID assigned by PECOS to the Group Practice that the individual professional works with- will be blank if the address is not linked to a Group Practice
Number of Group Practice members	2
	Total number of individual professionals affiliated with the Group Practice based on Group Practice PAC ID
Line 1 Street Address	1750 N RANDALL RD
	Group Practice or individual's line 1 address
Line 2 Street Address	SUITE 200
	Group Practice or individual's line 2 address
City	ELGIN
	Group Practice or individual's city
State	IL
	Group Practice or individual's state
Zip Code	601237903
	Group Practice or individual's zip code (9 digits when available)
Phone Number	8472770555
	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	140030
	Medicare CCN of hospital where individual professional provides service 1
Hospital Affiliation LBN 1	ADVOCATE SHERMAN HOSPITAL
	Legal business name of hospital where individual professional provides service 1
Hospital Affiliation CCN 2	140252
	Medicare CCN of hospital where individual professional provides service 2
Hospital Affiliation LBN 2	NORTHWEST COMMUNITY HOSPITAL 1
	Legal business name of hospital where individual professional provides service 2
Professional Accepts Medicare Assignment	Y