Physician Compare National (NPI:1245509108)

HEALTHCARE PROVIDER: ADEBAYO ADEWALE 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	1245509108
	Unique healthcare provider (clinician) ID assigned by NPPES
PECOS UID	4284850934
	Unique individual clinician ID assigned by PECOS
Professional Enrollment ID	I20141023002154
	Unique ID for the individual professional enrollment that is the source for the data in the observation
Provider Last Name	ADEWALE
	Individual professional last name
Provider First Name	ADEBAYO
	Individual professional first name
Provider Middle Name	SHAKIR
	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	1997
	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	4002 S LOOP
	Group Practice or individual's line 1 address
Line 2 Street Address	256 SUITE F
	Group Practice or individual's line 2 address
City	PALESTINE
	Group Practice or individual's city
State	TX
	Group Practice or individual's state
Zip Code	758018493
	Group Practice or individual's zip code (9 digits when available)

Hospital(s) Affiliation Information
Hospital Affiliation CCN 1	450747
	Medicare CCN of hospital where individual professional provides service 1
Hospital Affiliation LBN 1	PALESTINE REGIONAL MEDICAL CENTER
	Legal business name of hospital where individual professional provides service 1
Hospital Affiliation CCN 2	451393
	Medicare CCN of hospital where individual professional provides service 2
Hospital Affiliation CCN 3	450102
	Medicare CCN of hospital where individual professional provides service 3
Hospital Affiliation LBN 3	MOTHER FRANCES HOSPITAL
	Legal business name of hospital where individual professional provides service 3
Professional Accepts Medicare Assignment	Y