Physician Compare National (NPI:1093740599)

HEALTHCARE PROVIDER: GRACE NIKLAS 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	1093740599
	Unique healthcare provider (clinician) ID assigned by NPPES
PECOS UID	2163512831
	Unique individual clinician ID assigned by PECOS
Professional Enrollment ID	I20071218000443
	Unique ID for the individual professional enrollment that is the source for the data in the observation
Provider Last Name	NIKLAS
	Individual professional last name
Provider First Name	GRACE
	Individual professional first 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	1979
	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	210 WHITING ST
	Group Practice or individual's line 1 address
Line 2 Street Address	SUITE 4
	Group Practice or individual's line 2 address
City	HINGHAM
	Group Practice or individual's city
State	MA
	Group Practice or individual's state
Zip Code	020433724
	Group Practice or individual's zip code (9 digits when available)

Hospital(s) Affiliation Information
Hospital Affiliation CCN 1	220100
	Medicare CCN of hospital where individual professional provides service 1
Hospital Affiliation LBN 1	SOUTH SHORE HOSPITAL
	Legal business name of hospital where individual professional provides service 1
Hospital Affiliation CCN 2	220119
	Medicare CCN of hospital where individual professional provides service 2
Hospital Affiliation LBN 2	FAULKNER HOSPITAL-BRIGHAM AND WOMEN'S
	Legal business name of hospital where individual professional provides service 2
Professional Accepts Medicare Assignment	Y