Physician Compare National (NPI:1235122920)

HEALTHCARE PROVIDER: SURESH R GUDUR 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	1235122920
	Unique healthcare provider (clinician) ID assigned by NPPES
PECOS UID	5698678688
	Unique individual clinician ID assigned by PECOS
Professional Enrollment ID	I20040128000598
	Unique ID for the individual professional enrollment that is the source for the data in the observation
Provider Last Name	GUDUR
	Individual professional last name
Provider First Name	SURESH
	Individual professional first name
Provider Middle Name	R
	Individual professional middle name
Provider Gender	M
	The provider's gender if the provider is a person.
Provider Credential Text	MD
	The abbreviations for professional degrees or credentials used or held by the provider, if the provider is an individual. Examples are MD, DDS, CSW, CNA, AA, NP, RNA, or PSY. These credential designations will not be verified by NPS.

Medical School Information
Medical School Name	OTHER
	Individual professional's medical school
Graduation Year	1989
	Individual professional's medical school graduation year
Primary Specialty	INTERNAL MEDICINE
	Primary medical specialty reported by the individual professional in the selected enrollment
Secondary Specialty 1	FAMILY MEDICINE
	First secondary medical specialty reported by the individual professional in the selected enrollment
Secondary Specialty 2	GERIATRIC MEDICINE
	Second secondary medical specialty reported by the individual professional in the selected enrollment
All Secondary Specialties	FAMILY MEDICINE, GERIATRIC MEDICINE
	All four secondary specialties reported by the individual professional in the selected enrollment, separated by commas

Practice Information
Line 1 Street Address	416 PIRKLE FERRY RD
	Group Practice or individual's line 1 address
Line 2 Street Address	H400
	Group Practice or individual's line 2 address
City	CUMMING
	Group Practice or individual's city
State	GA
	Group Practice or individual's state
Zip Code	300409208
	Group Practice or individual's zip code (9 digits when available)

Hospital(s) Affiliation Information
Hospital Affiliation CCN 1	110005
	Medicare CCN of hospital where individual professional provides service 1
Hospital Affiliation LBN 1	NORTHSIDE HOSPITAL FORSYTH
	Legal business name of hospital where individual professional provides service 1
Hospital Affiliation CCN 2	110198
	Medicare CCN of hospital where individual professional provides service 2
Hospital Affiliation LBN 2	WELLSTAR NORTH FULTON HOSPITAL
	Legal business name of hospital where individual professional provides service 2
Professional Accepts Medicare Assignment	Y