Physician Compare National (NPI:1134138019)

HEALTHCARE PROVIDER: FAIYAAZ MUSTANSIR JHAVERI 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	1134138019
	Unique healthcare provider (clinician) ID assigned by NPPES
PECOS UID	8921290008
	Unique individual clinician ID assigned by PECOS
Professional Enrollment ID	I20101007000573
	Unique ID for the individual professional enrollment that is the source for the data in the observation
Provider Last Name	JHAVERI
	Individual professional last name
Provider First Name	FAIYAAZ
	Individual professional first name
Provider Middle Name	MUSTANSIR
	Individual professional middle name
Provider Gender	M
	The provider's gender if the provider is a person.

Medical School Information
Medical School Name	OREGON HEALTH SCIENCES UNIVERSITY SCHOOL OF MEDICINE
	Individual professional's medical school
Graduation Year	1993
	Individual professional's medical school graduation year
Primary Specialty	UROLOGY
	Primary medical specialty reported by the individual professional in the selected enrollment
Secondary Specialty 1	SURGICAL ONCOLOGY
	First secondary medical specialty reported by the individual professional in the selected enrollment
All Secondary Specialties	SURGICAL ONCOLOGY
	All four secondary specialties reported by the individual professional in the selected enrollment, separated by commas

Practice Information
Line 1 Street Address	2217 N BLVD W
	Group Practice or individual's line 1 address
City	DAVENPORT
	Group Practice or individual's city
State	FL
	Group Practice or individual's state
Zip Code	338378990
	Group Practice or individual's zip code (9 digits when available)

Hospital(s) Affiliation Information
Hospital Affiliation CCN 1	100137
	Medicare CCN of hospital where individual professional provides service 1
Hospital Affiliation LBN 1	HEART OF FLORIDA REGIONAL MEDICAL CENTER
	Legal business name of hospital where individual professional provides service 1
Hospital Affiliation CCN 2	100320
	Medicare CCN of hospital where individual professional provides service 2
Hospital Affiliation LBN 2	POINCIANA MEDICAL CENTER
	Legal business name of hospital where individual professional provides service 2
Professional Accepts Medicare Assignment	Y