Physician Compare National (NPI:1215357058)

HEALTHCARE PROVIDER: SEYEDALI HEJAZI 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	1215357058
	Unique healthcare provider (clinician) ID assigned by NPPES
PECOS UID	8527480193
	Unique individual clinician ID assigned by PECOS
Professional Enrollment ID	I20200629000547
	Unique ID for the individual professional enrollment that is the source for the data in the observation
Provider Last Name	HEJAZI
	Individual professional last name
Provider First Name	SEYEDALI
	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	NEUROLOGY
	Primary medical specialty reported by the individual professional in the selected enrollment

Practice Information
Organization Legal Name	PEACEHEALTH MEDICAL GROUP-SEDRO WOOLLEY
	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	1456584036
	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	51
	Total number of individual professionals affiliated with the Group Practice based on Group Practice PAC ID
Line 1 Street Address	1990 HOSPITAL DR
	Group Practice or individual's line 1 address
Line 2 Street Address	SUITE 100
	Group Practice or individual's line 2 address
City	SEDRO WOOLLEY
	Group Practice or individual's city
State	WA
	Group Practice or individual's state
Zip Code	982849315
	Group Practice or individual's zip code (9 digits when available)
Phone Number	3608564141
	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	500030
	Medicare CCN of hospital where individual professional provides service 1
Hospital Affiliation LBN 1	ST JOSEPH MEDICAL CENTER
	Legal business name of hospital where individual professional provides service 1
Hospital Affiliation CCN 2	501329
	Medicare CCN of hospital where individual professional provides service 2
Hospital Affiliation LBN 2	PEACEHEALTH UNITED GENERAL MEDICAL CENTER
	Legal business name of hospital where individual professional provides service 2
Professional Accepts Medicare Assignment	Y