Physician Compare National (NPI:1144371386)

HEALTHCARE PROVIDER: RICHARD REID MAXA 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	1144371386
	Unique healthcare provider (clinician) ID assigned by NPPES
PECOS UID	1254245152
	Unique individual clinician ID assigned by PECOS
Professional Enrollment ID	I20111026000939
	Unique ID for the individual professional enrollment that is the source for the data in the observation
Provider Last Name	MAXA
	Individual professional last name
Provider First Name	RICHARD
	Individual professional first name
Provider Middle Name	REID
	Individual professional middle name
Provider Gender	M
	The provider's gender if the provider is a person.

Medical School Information
Medical School Name	VANDERBILT UNIVERSITY SCHOOL OF MEDICINE
	Individual professional's medical school
Graduation Year	1993
	Individual professional's medical school graduation year
Primary Specialty	INTERNAL MEDICINE
	Primary medical specialty reported by the individual professional in the selected enrollment

Practice Information
Organization Legal Name	MAXA INTERNAL MEDICINE ASSOCIATES PC
	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	7113831017
	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	6
	Total number of individual professionals affiliated with the Group Practice based on Group Practice PAC ID
Line 1 Street Address	3505 DULUTH PARK LANE
	Group Practice or individual's line 1 address
Line 2 Street Address	BLDG 4 SUITE 400
	Group Practice or individual's line 2 address
City	DULUTH
	Group Practice or individual's city
State	GA
	Group Practice or individual's state
Zip Code	30096
	Group Practice or individual's zip code (9 digits when available)
Phone Number	6785973180
	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	110087
	Medicare CCN of hospital where individual professional provides service 1
Hospital Affiliation LBN 1	GWINNETT MEDICAL CENTER
	Legal business name of hospital where individual professional provides service 1
Hospital Affiliation CCN 2	110161
	Medicare CCN of hospital where individual professional provides service 2
Hospital Affiliation LBN 2	NORTHSIDE HOSPITAL
	Legal business name of hospital where individual professional provides service 2
Hospital Affiliation CCN 3	110192
	Medicare CCN of hospital where individual professional provides service 3
Hospital Affiliation LBN 3	EASTSIDE MEDICAL CENTER
	Legal business name of hospital where individual professional provides service 3
Hospital Affiliation CCN 4	110230
	Medicare CCN of hospital where individual professional provides service 4
Hospital Affiliation LBN 4	EMORY JOHNS CREEK HOSPITAL
	Legal business name of hospital where individual professional provides service 4
Professional Accepts Medicare Assignment	Y