Physician Compare National (NPI:1174576839)

HEALTHCARE PROVIDER: VIJAY SHANMUGAM 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	1174576839
	Unique healthcare provider (clinician) ID assigned by NPPES
PECOS UID	7012997778
	Unique individual clinician ID assigned by PECOS
Professional Enrollment ID	I20080303000314
	Unique ID for the individual professional enrollment that is the source for the data in the observation
Provider Last Name	SHANMUGAM
	Individual professional last name
Provider First Name	VIJAY
	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	1976
	Individual professional's medical school graduation year
Primary Specialty	NEUROLOGY
	Primary medical specialty reported by the individual professional in the selected enrollment

Practice Information
Line 1 Street Address	44215 N 15TH ST W
	Group Practice or individual's line 1 address
Line 2 Street Address	SUITE 204
	Group Practice or individual's line 2 address
City	LANCASTER
	Group Practice or individual's city
State	CA
	Group Practice or individual's state
Zip Code	935345504
	Group Practice or individual's zip code (9 digits when available)

Hospital(s) Affiliation Information
Hospital Affiliation CCN 1	050056
	Medicare CCN of hospital where individual professional provides service 1
Hospital Affiliation LBN 1	ANTELOPE VALLEY HOSPITAL
	Legal business name of hospital where individual professional provides service 1
Hospital Affiliation CCN 2	050204
	Medicare CCN of hospital where individual professional provides service 2
Hospital Affiliation LBN 2	PALMDALE REGIONAL MEDICAL CENTER
	Legal business name of hospital where individual professional provides service 2
Professional Accepts Medicare Assignment	M