Physician Compare National (NPI:1245345883)

HEALTHCARE PROVIDER: ROOPAL ANIL DESA 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	1245345883
	Unique healthcare provider (clinician) ID assigned by NPPES
PECOS UID	1153503057
	Unique individual clinician ID assigned by PECOS
Professional Enrollment ID	I20120105000719
	Unique ID for the individual professional enrollment that is the source for the data in the observation
Provider Last Name	DESA
	Individual professional last name
Provider First Name	ROOPAL
	Individual professional first name
Provider Middle Name	A
	Individual professional middle 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	1988
	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	4139 BAKER NEST
	Group Practice or individual's line 1 address
Line 2 Street Address	SUITE 900
	Group Practice or individual's line 2 address
City	COVINGTON
	Group Practice or individual's city
State	GA
	Group Practice or individual's state
Zip Code	300141409
	Group Practice or individual's zip code (9 digits when available)

Hospital(s) Affiliation Information
Hospital Affiliation CCN 1	110018
	Medicare CCN of hospital where individual professional provides service 1
Hospital Affiliation LBN 1	PIEDMONT NEWTON HOSPITAL
	Legal business name of hospital where individual professional provides service 1
Professional Accepts Medicare Assignment	Y