Physician Compare National (NPI:1093974867)

HEALTHCARE PROVIDER: DEEPAK GOPALA KRISHNAN DDS

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

Individual Professional Information
NPI	1093974867
	Unique healthcare provider (clinician) ID assigned by NPPES
PECOS UID	0941375265
	Unique individual clinician ID assigned by PECOS
Professional Enrollment ID	I20080821000404
	Unique ID for the individual professional enrollment that is the source for the data in the observation
Provider Last Name	GOPALAKRISHNAN
	Individual professional last name
Provider First Name	DEEPAK
	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	1996
	Individual professional's medical school graduation year
Primary Specialty	MAXILLOFACIAL SURGERY
	Primary medical specialty reported by the individual professional in the selected enrollment
Secondary Specialty 1	ORAL SURGERY
	First secondary medical specialty reported by the individual professional in the selected enrollment
All Secondary Specialties	ORAL SURGERY
	All four secondary specialties reported by the individual professional in the selected enrollment, separated by commas

Practice Information
Organization Legal Name	UNIVERSITY SURGICAL-DENTAL ASSOCIATES LLC
	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	1658384482
	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	6
	Total number of individual professionals affiliated with the Group Practice based on Group Practice PAC ID
Line 1 Street Address	222 PIEDMONT AVE
	Group Practice or individual's line 1 address
Line 2 Street Address	SUITE 7300
	Group Practice or individual's line 2 address
City	CINCINNATI
	Group Practice or individual's city
State	OH
	Group Practice or individual's state
Zip Code	452194224
	Group Practice or individual's zip code (9 digits when available)
Phone Number	5134758783
	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	360003
	Medicare CCN of hospital where individual professional provides service 1
Hospital Affiliation LBN 1	UNIVERSITY OF CINCINNATI MEDICAL CENTER, LLC
	Legal business name of hospital where individual professional provides service 1
Professional Accepts Medicare Assignment	Y