Physician Compare National (NPI:1265758502)

HEALTHCARE PROVIDER: OGHENERUKEVWE ODIETE 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	1265758502
	Unique healthcare provider (clinician) ID assigned by NPPES
PECOS UID	1658540059
	Unique individual clinician ID assigned by PECOS
Professional Enrollment ID	I20170714002676
	Unique ID for the individual professional enrollment that is the source for the data in the observation
Provider Last Name	ODIETE
	Individual professional last name
Provider First Name	OGHENERUKEVWE
	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	2008
	Individual professional's medical school graduation year
Primary Specialty	INTERVENTIONAL CARDIOLOGY
	Primary medical specialty reported by the individual professional in the selected enrollment
Secondary Specialty 1	CARDIOVASCULAR DISEASE (CARDIOLOGY)
	First secondary medical specialty reported by the individual professional in the selected enrollment
All Secondary Specialties	CARDIOVASCULAR DISEASE (CARDIOLOGY)
	All four secondary specialties reported by the individual professional in the selected enrollment, separated by commas

Practice Information
Line 1 Street Address	1825 HWY 34 E
	Group Practice or individual's line 1 address
Line 2 Street Address	SUITE 3400
	Group Practice or individual's line 2 address
City	NEWNAN
	Group Practice or individual's city
State	GA
	Group Practice or individual's state
Zip Code	302656423
	Group Practice or individual's zip code (9 digits when available)

Hospital(s) Affiliation Information
Hospital Affiliation CCN 1	110016
	Medicare CCN of hospital where individual professional provides service 1
Hospital Affiliation LBN 1	WEST GEORGIA MEDICAL CENTER, INC
	Legal business name of hospital where individual professional provides service 1
Hospital Affiliation CCN 2	110029
	Medicare CCN of hospital where individual professional provides service 2
Hospital Affiliation LBN 2	NORTHEAST GEORGIA MEDICAL CENTER, INC
	Legal business name of hospital where individual professional provides service 2
Professional Accepts Medicare Assignment	Y