Physician Compare National (NPI:1104002666)

HEALTHCARE PROVIDER: PRASANNA SAMPURNA SRINAGESH 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	1104002666
	Unique healthcare provider (clinician) ID assigned by NPPES
PECOS UID	2264518026
	Unique individual clinician ID assigned by PECOS
Professional Enrollment ID	I20111005000769
	Unique ID for the individual professional enrollment that is the source for the data in the observation
Provider Last Name	SRINAGESH
	Individual professional last name
Provider First Name	PRASANNA
	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	1999
	Individual professional's medical school graduation year
Primary Specialty	NEPHROLOGY
	Primary medical specialty reported by the individual professional in the selected enrollment
Secondary Specialty 1	INTERNAL MEDICINE
	First secondary medical specialty reported by the individual professional in the selected enrollment
All Secondary Specialties	INTERNAL MEDICINE
	All four secondary specialties reported by the individual professional in the selected enrollment, separated by commas

Practice Information
Line 1 Street Address	220 UVALDA ST
	Group Practice or individual's line 1 address
City	WAYCROSS
	Group Practice or individual's city
State	GA
	Group Practice or individual's state
Zip Code	315014569
	Group Practice or individual's zip code (9 digits when available)

Hospital(s) Affiliation Information
Hospital Affiliation CCN 1	110003
	Medicare CCN of hospital where individual professional provides service 1
Hospital Affiliation LBN 1	MAYO CLINIC HEALTH SYSTEM IN WAYCROSS
	Legal business name of hospital where individual professional provides service 1
Hospital Affiliation CCN 2	111327
	Medicare CCN of hospital where individual professional provides service 2
Hospital Affiliation LBN 2	BACON COUNTY HOSPITAL
	Legal business name of hospital where individual professional provides service 2
Hospital Affiliation CCN 3	110089
	Medicare CCN of hospital where individual professional provides service 3
Hospital Affiliation LBN 3	COFFEE REGIONAL MEDICAL CENTER
	Legal business name of hospital where individual professional provides service 3
Hospital Affiliation CCN 4	111333
	Medicare CCN of hospital where individual professional provides service 4
Hospital Affiliation LBN 4	JEFF DAVIS HOSPITAL
	Legal business name of hospital where individual professional provides service 4
Hospital Affiliation CCN 5	111308
	Medicare CCN of hospital where individual professional provides service 5
Hospital Affiliation LBN 5	CLINCH MEMORIAL HOSPITAL
	Legal business name of hospital where individual professional provides service 5
Professional Accepts Medicare Assignment	Y

Physician Compare National (NPI:1104002666)

HEALTHCARE PROVIDER: PRASANNA SAMPURNA SRINAGESH M.D.

Individual Professional Information

Medical School Information

Practice Information

Hospital(s) Affiliation Information