Physician Compare National (NPI:1245259910)

HEALTHCARE PROVIDER: FAROOQ A MIRZA M.D.

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

Individual Professional Information
NPI	1245259910
	Unique healthcare provider (clinician) ID assigned by NPPES
PECOS UID	4082794599
	Unique individual clinician ID assigned by PECOS
Professional Enrollment ID	I20080109000215
	Unique ID for the individual professional enrollment that is the source for the data in the observation
Provider Last Name	MIRZA
	Individual professional last name
Provider First Name	FAROOQ
	Individual professional first name
Provider Middle Name	A
	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	1975
	Individual professional's medical school graduation year
Primary Specialty	GENERAL SURGERY
	Primary medical specialty reported by the individual professional in the selected enrollment
Secondary Specialty 1	VASCULAR SURGERY
	First secondary medical specialty reported by the individual professional in the selected enrollment
All Secondary Specialties	VASCULAR SURGERY
	All four secondary specialties reported by the individual professional in the selected enrollment, separated by commas

Practice Information
Organization Legal Name	CCMH CORPORATION
	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	2365540465
	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	10
	Total number of individual professionals affiliated with the Group Practice based on Group Practice PAC ID
Line 1 Street Address	309 11TH ST
	Group Practice or individual's line 1 address
City	CARROLLTON
	Group Practice or individual's city
State	KY
	Group Practice or individual's state
Zip Code	410081435
	Group Practice or individual's zip code (9 digits when available)

Hospital(s) Affiliation Information
Hospital Affiliation CCN 1	181310
	Medicare CCN of hospital where individual professional provides service 1
Hospital Affiliation LBN 1	CARROLL COUNTY MEMORIAL HOSPITAL
	Legal business name of hospital where individual professional provides service 1
Professional Accepts Medicare Assignment	Y