Physician Compare National (NPI:1225385693)

HEALTHCARE PROVIDER: MYRIAM ELKOSSEIFI 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	1225385693
	Unique healthcare provider (clinician) ID assigned by NPPES
PECOS UID	5799087433
	Unique individual clinician ID assigned by PECOS
Professional Enrollment ID	I20171114002954
	Unique ID for the individual professional enrollment that is the source for the data in the observation
Provider Last Name	ELKOSSEIFI
	Individual professional last name
Provider First Name	MYRIAM
	Individual professional first name
Provider Gender	F
	The provider's gender if the provider is a person.

Medical School Information
Medical School Name	OTHER
	Individual professional's medical school
Graduation Year	2011
	Individual professional's medical school graduation year
Primary Specialty	ENDOCRINOLOGY
	Primary medical specialty reported by the individual professional in the selected enrollment

Practice Information
Organization Legal Name	METABOLIC DISEASE ASSOCIATES, 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	5799686614
	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	13
	Total number of individual professionals affiliated with the Group Practice based on Group Practice PAC ID
Line 1 Street Address	240 W 11TH ST
	Group Practice or individual's line 1 address
Line 2 Street Address	2ND FL
	Group Practice or individual's line 2 address
City	ERIE
	Group Practice or individual's city
State	PA
	Group Practice or individual's state
Zip Code	165011702
	Group Practice or individual's zip code (9 digits when available)
Phone Number	8144522218
	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	390113
	Medicare CCN of hospital where individual professional provides service 1
Hospital Affiliation LBN 1	MEADVILLE MEDICAL CENTER
	Legal business name of hospital where individual professional provides service 1
Hospital Affiliation CCN 2	390009
	Medicare CCN of hospital where individual professional provides service 2
Hospital Affiliation LBN 2	SAINT VINCENT HOSPITAL
	Legal business name of hospital where individual professional provides service 2
Hospital Affiliation CCN 3	330239
	Medicare CCN of hospital where individual professional provides service 3
Hospital Affiliation LBN 3	UPMC CHAUTAUQUA WCA
	Legal business name of hospital where individual professional provides service 3
Hospital Affiliation CCN 4	390146
	Medicare CCN of hospital where individual professional provides service 4
Hospital Affiliation LBN 4	WARREN GENERAL HOSPITAL
	Legal business name of hospital where individual professional provides service 4
Hospital Affiliation CCN 5	330103
	Medicare CCN of hospital where individual professional provides service 5
Hospital Affiliation LBN 5	OLEAN GENERAL HOSPITAL
	Legal business name of hospital where individual professional provides service 5
Professional Accepts Medicare Assignment	Y

Physician Compare National (NPI:1225385693)

HEALTHCARE PROVIDER: MYRIAM ELKOSSEIFI MD

Individual Professional Information

Medical School Information

Practice Information

Hospital(s) Affiliation Information