Physician Compare National (NPI:1205802584)

HEALTHCARE PROVIDER: EDWARD KIRKHAM GORE 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	1205802584
	Unique healthcare provider (clinician) ID assigned by NPPES
PECOS UID	0941469019
	Unique individual clinician ID assigned by PECOS
Professional Enrollment ID	I20120308000549
	Unique ID for the individual professional enrollment that is the source for the data in the observation
Provider Last Name	GORE
	Individual professional last name
Provider First Name	EDWARD
	Individual professional first name
Provider Middle Name	KIRKHAM
	Individual professional middle name
Provider Gender	M
	The provider's gender if the provider is a person.

Medical School Information
Medical School Name	UNIVERSITY OF MISSISSIPPI SCHOOL OF MEDICINE
	Individual professional's medical school
Graduation Year	1964
	Individual professional's medical school graduation year
Primary Specialty	GENERAL PRACTICE
	Primary medical specialty reported by the individual professional in the selected enrollment

Practice Information
Organization Legal Name	SOUTHERN HEALTH CORP OF HOUSTON, INC.
	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	0042102352
	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	4
	Total number of individual professionals affiliated with the Group Practice based on Group Practice PAC ID
Line 1 Street Address	1002 E MADISON ST
	Group Practice or individual's line 1 address
Line 2 Street Address	TRACE REGIONAL HOSPITAL
	Group Practice or individual's line 2 address
City	HOUSTON
	Group Practice or individual's city
State	MS
	Group Practice or individual's state
Zip Code	388512428
	Group Practice or individual's zip code (9 digits when available)
Phone Number	6624561163
	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	250017
	Medicare CCN of hospital where individual professional provides service 1
Hospital Affiliation LBN 1	TRACE REGIONAL HOSP AND SWING BED
	Legal business name of hospital where individual professional provides service 1
Hospital Affiliation CCN 2	251331
	Medicare CCN of hospital where individual professional provides service 2
Hospital Affiliation LBN 2	BMH-CALHOUN
	Legal business name of hospital where individual professional provides service 2
Professional Accepts Medicare Assignment	Y