Physician Compare National (NPI:1083029060)

HEALTHCARE PROVIDER: EJODAMEN BLESSING SHOBOWALE 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	1083029060
	Unique healthcare provider (clinician) ID assigned by NPPES
PECOS UID	1557636446
	Unique individual clinician ID assigned by PECOS
Professional Enrollment ID	I20171003004653
	Unique ID for the individual professional enrollment that is the source for the data in the observation
Provider Last Name	SHOBOWALE
	Individual professional last name
Provider First Name	EJODAMEN
	Individual professional first name
Provider Middle Name	BLESSING
	Individual professional middle name
Provider Gender	F
	The provider's gender if the provider is a person.

Medical School Information
Medical School Name	OTHER
	Individual professional's medical school
Graduation Year	2014
	Individual professional's medical school graduation year
Primary Specialty	PODIATRY
	Primary medical specialty reported by the individual professional in the selected enrollment

Practice Information
Organization Legal Name	PREFERRED PODIATRY GROUP PC
	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	3971412677
	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	93
	Total number of individual professionals affiliated with the Group Practice based on Group Practice PAC ID
Line 1 Street Address	1900 MEDICAL PKWY
	Group Practice or individual's line 1 address
City	SAN MARCOS
	Group Practice or individual's city
State	TX
	Group Practice or individual's state
Zip Code	786667520
	Group Practice or individual's zip code (9 digits when available)
Phone Number	5123961888
	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	450775
	Medicare CCN of hospital where individual professional provides service 1
Hospital Affiliation LBN 1	KINGWOOD MEDICAL CENTER
	Legal business name of hospital where individual professional provides service 1
Hospital Affiliation CCN 2	450068
	Medicare CCN of hospital where individual professional provides service 2
Hospital Affiliation LBN 2	MEMORIAL HERMANN - TEXAS MEDICAL CENTER
	Legal business name of hospital where individual professional provides service 2
Professional Accepts Medicare Assignment	Y