Physician Compare National (NPI:1215935945)

HEALTHCARE PROVIDER:

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

Individual Professional Information
NPI	1215935945
	Unique healthcare provider (clinician) ID assigned by NPPES
PECOS UID	0446235758
	Unique individual clinician ID assigned by PECOS
Professional Enrollment ID	I20120117000496
	Unique ID for the individual professional enrollment that is the source for the data in the observation
Provider Last Name	PRABHAKAR
	Individual professional last name
Provider First Name	SHYAM
	Individual professional first name
Provider Middle Name	SUNDER
	Individual professional middle 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	1973
	Individual professional's medical school graduation year
Primary Specialty	CARDIOVASCULAR DISEASE (CARDIOLOGY)
	Primary medical specialty reported by the individual professional in the selected enrollment
Secondary Specialty 1	INTERNAL MEDICINE
	First secondary medical specialty reported by the individual professional in the selected enrollment
All Secondary Specialties	INTERNAL MEDICINE
	All four secondary specialties reported by the individual professional in the selected enrollment, separated by commas

Practice Information
Line 1 Street Address	865 MERRICK RD
	Group Practice or individual's line 1 address
Line 2 Street Address	SUITE 204
	Group Practice or individual's line 2 address
City	BALDWIN
	Group Practice or individual's city
State	NY
	Group Practice or individual's state
Zip Code	115103338
	Group Practice or individual's zip code (9 digits when available)
Phone Number	5162237744
	Phone number is listed only when there is a single phone number available for the practice location address

Hospital(s) Affiliation Information
Professional Accepts Medicare Assignment	Y