Physician Compare National (NPI:1164717054)

HEALTHCARE PROVIDER: GIOVANNI FADDOUL 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	1164717054
	Unique healthcare provider (clinician) ID assigned by NPPES
PECOS UID	6507134533
	Unique individual clinician ID assigned by PECOS
Professional Enrollment ID	I20200707000625
	Unique ID for the individual professional enrollment that is the source for the data in the observation
Provider Last Name	FADDOUL
	Individual professional last name
Provider First Name	GEOVANI
	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	2010
	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	ALBANY MEDICAL COLLEGE
	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	1759293111
	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	790
	Total number of individual professionals affiliated with the Group Practice based on Group Practice PAC ID
Line 1 Street Address	47 NEW SCOTLAND AVE
	Group Practice or individual's line 1 address
City	ALBANY
	Group Practice or individual's city
State	NY
	Group Practice or individual's state
Zip Code	122083412
	Group Practice or individual's zip code (9 digits when available)

Hospital(s) Affiliation Information
Hospital Affiliation CCN 1	420070
	Medicare CCN of hospital where individual professional provides service 1
Hospital Affiliation LBN 1	TUOMEY HEALTHCARE SYSTEM
	Legal business name of hospital where individual professional provides service 1
Hospital Affiliation CCN 2	330013
	Medicare CCN of hospital where individual professional provides service 2
Hospital Affiliation LBN 2	ALBANY MEDICAL CENTER HOSPITAL
	Legal business name of hospital where individual professional provides service 2
Hospital Affiliation CCN 3	420109
	Medicare CCN of hospital where individual professional provides service 3
Hospital Affiliation LBN 3	MCLEOD HEALTH CLARENDON
	Legal business name of hospital where individual professional provides service 3
Professional Accepts Medicare Assignment	Y