Physician Compare National (NPI:1275595753)

HEALTHCARE PROVIDER: HARRY H SHARATA MD, PH.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	1275595753
	Unique healthcare provider (clinician) ID assigned by NPPES
PECOS UID	9931172632
	Unique individual clinician ID assigned by PECOS
Professional Enrollment ID	I20190416000308
	Unique ID for the individual professional enrollment that is the source for the data in the observation
Provider Last Name	SHARATA
	Individual professional last name
Provider First Name	HARRY
	Individual professional first name
Provider Middle Name	H
	Individual professional middle name
Provider Gender	M
	The provider's gender if the provider is a person.
Provider Credential Text	MD
	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	UNIVERSITY OF WISCONSIN SCHOOL OF MEDICINE
	Individual professional's medical school
Graduation Year	1990
	Individual professional's medical school graduation year
Primary Specialty	DERMATOLOGY
	Primary medical specialty reported by the individual professional in the selected enrollment

Practice Information
Line 1 Street Address	1036 W STEPHENSON ST
	Group Practice or individual's line 1 address
Line 2 Street Address	FL 3
	Group Practice or individual's line 2 address
City	FREEPORT
	Group Practice or individual's city
State	IL
	Group Practice or individual's state
Zip Code	610324865
	Group Practice or individual's zip code (9 digits when available)

Hospital(s) Affiliation Information
Hospital Affiliation CCN 1	140160
	Medicare CCN of hospital where individual professional provides service 1
Hospital Affiliation LBN 1	FHN MEMORIAL HOSPITAL
	Legal business name of hospital where individual professional provides service 1
Hospital Affiliation CCN 2	520028
	Medicare CCN of hospital where individual professional provides service 2
Hospital Affiliation LBN 2	THE MONROE CLINIC
	Legal business name of hospital where individual professional provides service 2
Professional Accepts Medicare Assignment	Y