Physician Compare National (NPI:1114248424)

HEALTHCARE PROVIDER: WISIT CHEUNGPASITPORN 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	1114248424
	Unique healthcare provider (clinician) ID assigned by NPPES
PECOS UID	9032359393
	Unique individual clinician ID assigned by PECOS
Professional Enrollment ID	I20170602000418
	Unique ID for the individual professional enrollment that is the source for the data in the observation
Provider Last Name	CHEUNGPASITPORN
	Individual professional last name
Provider First Name	WISIT
	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	2007
	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
Organization Legal Name	STATE OF MISSISSIPPI-UNIVERSITY OF MISSISSIPPI MEDICAL CENTER
	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	1850293036
	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	817
	Total number of individual professionals affiliated with the Group Practice based on Group Practice PAC ID
Line 1 Street Address	965 AVENT DR
	Group Practice or individual's line 1 address
Line 2 Street Address	100A
	Group Practice or individual's line 2 address
City	GRENADA
	Group Practice or individual's city
State	MS
	Group Practice or individual's state
Zip Code	389015045
	Group Practice or individual's zip code (9 digits when available)
Phone Number	6622277444
	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	250001
	Medicare CCN of hospital where individual professional provides service 1
Hospital Affiliation LBN 1	UNIVERSITY OF MISSISSIPPI MED CENTER
	Legal business name of hospital where individual professional provides service 1
Hospital Affiliation CCN 2	250168
	Medicare CCN of hospital where individual professional provides service 2
Hospital Affiliation LBN 2	UNIVERSITY OF MISSISSIPPI MEDICAL CENTER- GRENADA
	Legal business name of hospital where individual professional provides service 2
Hospital Affiliation CCN 3	250004
	Medicare CCN of hospital where individual professional provides service 3
Hospital Affiliation LBN 3	NORTH MISSISSIPPI MEDICAL CENTER
	Legal business name of hospital where individual professional provides service 3
Hospital Affiliation CCN 4	010113
	Medicare CCN of hospital where individual professional provides service 4
Hospital Affiliation LBN 4	MOBILE INFIRMARY MEDICAL CENTER
	Legal business name of hospital where individual professional provides service 4
Hospital Affiliation CCN 5	250019
	Medicare CCN of hospital where individual professional provides service 5
Hospital Affiliation LBN 5	MEMORIAL HOSPITAL AT GULFPORT
	Legal business name of hospital where individual professional provides service 5
Professional Accepts Medicare Assignment	Y