Physician Compare National (NPI:1215279625)

HEALTHCARE PROVIDER: FARIS K AZAR 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	1215279625
	Unique healthcare provider (clinician) ID assigned by NPPES
PECOS UID	1052551496
	Unique individual clinician ID assigned by PECOS
Professional Enrollment ID	I20191211001698
	Unique ID for the individual professional enrollment that is the source for the data in the observation
Provider Last Name	AZAR
	Individual professional last name
Provider First Name	FARIS
	Individual professional first name
Provider Middle Name	K
	Individual professional middle name
Provider Gender	M
	The provider's gender if the provider is a person.

Medical School Information
Medical School Name	BOSTON UNIVERSITY SCHOOL OF MEDICINE
	Individual professional's medical school
Graduation Year	2013
	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	PALM BEACH TRAUMA ASSOCIATES
	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	8628311750
	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	7
	Total number of individual professionals affiliated with the Group Practice based on Group Practice PAC ID
Line 1 Street Address	901 45TH ST
	Group Practice or individual's line 1 address
City	MANGONIA PARK
	Group Practice or individual's city
State	FL
	Group Practice or individual's state
Zip Code	334072413
	Group Practice or individual's zip code (9 digits when available)

Hospital(s) Affiliation Information
Hospital Affiliation CCN 1	100288
	Medicare CCN of hospital where individual professional provides service 1
Hospital Affiliation LBN 1	ST MARY'S MEDICAL CENTER
	Legal business name of hospital where individual professional provides service 1
Hospital Affiliation CCN 2	100176
	Medicare CCN of hospital where individual professional provides service 2
Hospital Affiliation LBN 2	PALM BEACH GARDENS MEDICAL CENTER
	Legal business name of hospital where individual professional provides service 2
Professional Accepts Medicare Assignment	M