Physician Compare National (NPI:1235275900)

HEALTHCARE PROVIDER: PROSPERITY EZEANUNA 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	1235275900
	Unique healthcare provider (clinician) ID assigned by NPPES
PECOS UID	2860569795
	Unique individual clinician ID assigned by PECOS
Professional Enrollment ID	I20100608000392
	Unique ID for the individual professional enrollment that is the source for the data in the observation
Provider Last Name	EZEANUNA
	Individual professional last name
Provider First Name	PROSPERITY
	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	1996
	Individual professional's medical school graduation year
Primary Specialty	INTERNAL MEDICINE
	Primary medical specialty reported by the individual professional in the selected enrollment

Practice Information
Line 1 Street Address	1673 BRIARCREST DR
	Group Practice or individual's line 1 address
Line 2 Street Address	SUITE 100B
	Group Practice or individual's line 2 address
City	BRYAN
	Group Practice or individual's city
State	TX
	Group Practice or individual's state
Zip Code	778022756
	Group Practice or individual's zip code (9 digits when available)
Phone Number	9794022115
	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	450011
	Medicare CCN of hospital where individual professional provides service 1
Hospital Affiliation LBN 1	CHI ST JOSEPH HEALTH
	Legal business name of hospital where individual professional provides service 1
Hospital Affiliation CCN 2	450299
	Medicare CCN of hospital where individual professional provides service 2
Hospital Affiliation LBN 2	COLLEGE STATION MEDICAL CENTER
	Legal business name of hospital where individual professional provides service 2
Hospital Affiliation CCN 3	670088
	Medicare CCN of hospital where individual professional provides service 3
Hospital Affiliation LBN 3	BAYLOR SCOTT & WHITE MEDICAL CENTER- COLLEGE STATI
	Legal business name of hospital where individual professional provides service 3
Professional Accepts Medicare Assignment	Y