Physician Compare National (NPI:1134215569)

HEALTHCARE PROVIDER: KUMAR DAMODARAN MOOLAYIL 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	1134215569
	Unique healthcare provider (clinician) ID assigned by NPPES
PECOS UID	7618157793
	Unique individual clinician ID assigned by PECOS
Professional Enrollment ID	I20110207000441
	Unique ID for the individual professional enrollment that is the source for the data in the observation
Provider Last Name	MOOLAYIL
	Individual professional last name
Provider First Name	KUMAR
	Individual professional first name
Provider Middle Name	D
	Individual professional middle 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	1976
	Individual professional's medical school graduation year
Primary Specialty	PSYCHIATRY
	Primary medical specialty reported by the individual professional in the selected enrollment
Secondary Specialty 1	ADDICTION MEDICINE
	First secondary medical specialty reported by the individual professional in the selected enrollment
Secondary Specialty 2	GERIATRIC PSYCHIATRY
	Second secondary medical specialty reported by the individual professional in the selected enrollment
All Secondary Specialties	ADDICTION MEDICINE, GERIATRIC PSYCHIATRY
	All four secondary specialties reported by the individual professional in the selected enrollment, separated by commas

Practice Information
Line 1 Street Address	15475 S PARK
	Group Practice or individual's line 1 address
Line 2 Street Address	102A
	Group Practice or individual's line 2 address
City	SOUTH HOLLAND
	Group Practice or individual's city
State	IL
	Group Practice or individual's state
Zip Code	604731378
	Group Practice or individual's zip code (9 digits when available)
Phone Number	7085962211
	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	140191
	Medicare CCN of hospital where individual professional provides service 1
Hospital Affiliation LBN 1	INGALLS MEMORIAL HOSPITAL
	Legal business name of hospital where individual professional provides service 1
Professional Accepts Medicare Assignment	Y