Physician Compare National (NPI:1144466111)

HEALTHCARE PROVIDER: PEERAWUT DEEPRASERTKUL

Physician Compare National contains general information about individual eligible professionals (EPs) such as demographic information and Medicare quality program participation.

Individual Professional Information
NPI	1144466111
	Unique healthcare provider (clinician) ID assigned by NPPES
PECOS UID	7618261918
	Unique individual clinician ID assigned by PECOS
Professional Enrollment ID	I20160809003217
	Unique ID for the individual professional enrollment that is the source for the data in the observation
Provider Last Name	DEEPRASERTKUL
	Individual professional last name
Provider First Name	PEERAWUT
	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	2004
	Individual professional's medical school graduation year
Primary Specialty	CARDIOVASCULAR DISEASE (CARDIOLOGY)
	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	MERCY 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	7416851381
	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	34
	Total number of individual professionals affiliated with the Group Practice based on Group Practice PAC ID
Line 1 Street Address	1213 15TH AVE W
	Group Practice or individual's line 1 address
City	WILLISTON
	Group Practice or individual's city
State	ND
	Group Practice or individual's state
Zip Code	588013895
	Group Practice or individual's zip code (9 digits when available)
Phone Number	7015727651
	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	351334
	Medicare CCN of hospital where individual professional provides service 1
Hospital Affiliation LBN 1	CHI ST ALEXIUS HEALTH WILLISTON
	Legal business name of hospital where individual professional provides service 1
Hospital Affiliation CCN 2	350002
	Medicare CCN of hospital where individual professional provides service 2
Hospital Affiliation LBN 2	CHI ST ALEXIUS HEALTH
	Legal business name of hospital where individual professional provides service 2
Hospital Affiliation CCN 3	351300
	Medicare CCN of hospital where individual professional provides service 3
Hospital Affiliation LBN 3	TIOGA MEDICAL CENTER
	Legal business name of hospital where individual professional provides service 3
Hospital Affiliation CCN 4	350006
	Medicare CCN of hospital where individual professional provides service 4
Hospital Affiliation LBN 4	TRINITY HOSPITALS
	Legal business name of hospital where individual professional provides service 4
Hospital Affiliation CCN 5	351310
	Medicare CCN of hospital where individual professional provides service 5
Hospital Affiliation LBN 5	SAKAKAWEA MEDICAL CENTER - CAH
	Legal business name of hospital where individual professional provides service 5
Professional Accepts Medicare Assignment	Y

Physician Compare National (NPI:1144466111)

HEALTHCARE PROVIDER: PEERAWUT DEEPRASERTKUL

Individual Professional Information

Medical School Information

Practice Information

Hospital(s) Affiliation Information