Physician Compare National (NPI:1255392536)

HEALTHCARE PROVIDER: BOONPON THONGTEUM NP

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

Individual Professional Information
NPI	1255392536
	Unique healthcare provider (clinician) ID assigned by NPPES
PECOS UID	9133021652
	Unique individual clinician ID assigned by PECOS
Professional Enrollment ID	I20040124000207
	Unique ID for the individual professional enrollment that is the source for the data in the observation
Provider Last Name	THONGTEUM
	Individual professional last name
Provider First Name	BOONPON
	Individual professional first name
Provider Gender	M
	The provider's gender if the provider is a person.
Provider Credential Text	NP
	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	OHIO STATE UNIVERSITY COLLEGE OF MEDICINE
	Individual professional's medical school
Graduation Year	2003
	Individual professional's medical school graduation year
Primary Specialty	NURSE PRACTITIONER
	Primary medical specialty reported by the individual professional in the selected enrollment

Practice Information
Organization Legal Name	FORSYTH MEDICAL GROUP, LLC
	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	3678478054
	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	42
	Total number of individual professionals affiliated with the Group Practice based on Group Practice PAC ID
Line 1 Street Address	100 JOHNSON RIDGE MEDICAL PARK
	Group Practice or individual's line 1 address
City	ELKIN
	Group Practice or individual's city
State	NC
	Group Practice or individual's state
Zip Code	286212400
	Group Practice or individual's zip code (9 digits when available)
Phone Number	3365263005
	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	340014
	Medicare CCN of hospital where individual professional provides service 1
Hospital Affiliation LBN 1	NOVANT HEALTH FORSYTH MEDICAL CENTER
	Legal business name of hospital where individual professional provides service 1
Professional Accepts Medicare Assignment	Y