Physician Compare National (NPI:1104269943)

HEALTHCARE PROVIDER: MUSTAFA MAHMOUD HADDAD 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	1104269943
	Unique healthcare provider (clinician) ID assigned by NPPES
PECOS UID	1456591858
	Unique individual clinician ID assigned by PECOS
Professional Enrollment ID	I20190514000437
	Unique ID for the individual professional enrollment that is the source for the data in the observation
Provider Last Name	HADDAD
	Individual professional last name
Provider First Name	MUSTAFA
	Individual professional first name
Provider Middle Name	MAHMOUD
	Individual professional middle name
Provider Gender	M
	The provider's gender if the provider is a person.

Medical School Information
Medical School Name	UNIVERSITY OF TENNESSEE, HSC, COLLEGE OF MEDICINE
	Individual professional's medical school
Graduation Year	2013
	Individual professional's medical school graduation year
Primary Specialty	DIAGNOSTIC RADIOLOGY
	Primary medical specialty reported by the individual professional in the selected enrollment

Practice Information
Organization Legal Name	RADIOLOGY IMAGING OF NEBRASKA 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	5597828269
	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	105
	Total number of individual professionals affiliated with the Group Practice based on Group Practice PAC ID
Line 1 Street Address	10700 E GEDDES AVE
	Group Practice or individual's line 1 address
Line 2 Street Address	SUITE 200
	Group Practice or individual's line 2 address
City	ENGLEWOOD
	Group Practice or individual's city
State	CO
	Group Practice or individual's state
Zip Code	801123861
	Group Practice or individual's zip code (9 digits when available)

Hospital(s) Affiliation Information
Hospital Affiliation CCN 1	060001
	Medicare CCN of hospital where individual professional provides service 1
Hospital Affiliation LBN 1	NORTH COLORADO MEDICAL CENTER
	Legal business name of hospital where individual professional provides service 1
Hospital Affiliation CCN 2	060030
	Medicare CCN of hospital where individual professional provides service 2
Hospital Affiliation LBN 2	MCKEE MEDICAL CENTER
	Legal business name of hospital where individual professional provides service 2
Hospital Affiliation CCN 3	280061
	Medicare CCN of hospital where individual professional provides service 3
Hospital Affiliation LBN 3	REGIONAL WEST MEDICAL CENTER
	Legal business name of hospital where individual professional provides service 3
Hospital Affiliation CCN 4	060034
	Medicare CCN of hospital where individual professional provides service 4
Hospital Affiliation LBN 4	HCA-HEALTHONE DBA SWEDISH MEDICAL CENTER
	Legal business name of hospital where individual professional provides service 4
Professional Accepts Medicare Assignment	Y