Physician Compare National (NPI:1194811505)

HEALTHCARE PROVIDER: DONALD ROY GEDAROVICH MD

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

Individual Professional Information
NPI	1194811505
	Unique healthcare provider (clinician) ID assigned by NPPES
PECOS UID	1951334945
	Unique individual clinician ID assigned by PECOS
Professional Enrollment ID	I20050912000068
	Unique ID for the individual professional enrollment that is the source for the data in the observation
Provider Last Name	GEDAROVICH
	Individual professional last name
Provider First Name	DONALD
	Individual professional first name
Provider Middle Name	R
	Individual professional middle name
Provider Gender	M
	The provider's gender if the provider is a person.
Provider Credential Text	MD
	The abbreviations for professional degrees or credentials used or held by the provider, if the provider is an individual. Examples are MD, DDS, CSW, CNA, AA, NP, RNA, or PSY. These credential designations will not be verified by NPS.

Medical School Information
Medical School Name	UNIVERSITY OF CALIFORNIA, SAN FRANCISCO SCHOOL OF MEDICINE
	Individual professional's medical school
Graduation Year	1979
	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
Line 1 Street Address	1426 MAIN ST
	Group Practice or individual's line 1 address
Line 2 Street Address	SUITE 5
	Group Practice or individual's line 2 address
City	WALPOLE
	Group Practice or individual's city
State	MA
	Group Practice or individual's state
Zip Code	020811700
	Group Practice or individual's zip code (9 digits when available)

Hospital(s) Affiliation Information
Hospital Affiliation CCN 1	220126
	Medicare CCN of hospital where individual professional provides service 1
Hospital Affiliation LBN 1	NORWOOD HOSPITAL
	Legal business name of hospital where individual professional provides service 1
Hospital Affiliation CCN 2	220110
	Medicare CCN of hospital where individual professional provides service 2
Hospital Affiliation LBN 2	BRIGHAM AND WOMEN'S HOSPITAL
	Legal business name of hospital where individual professional provides service 2
Professional Accepts Medicare Assignment	Y