Physician Compare National (NPI:1285614016)

HEALTHCARE PROVIDER: MARK SAMUEL SIEGEL 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	1285614016
	Unique healthcare provider (clinician) ID assigned by NPPES
PECOS UID	2961488432
	Unique individual clinician ID assigned by PECOS
Professional Enrollment ID	I20040625000351
	Unique ID for the individual professional enrollment that is the source for the data in the observation
Provider Last Name	SIEGEL
	Individual professional last name
Provider First Name	MARK
	Individual professional first name
Provider Middle Name	SAMUEL
	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 VIRGINIA SCHOOL OF MEDICINE
	Individual professional's medical school
Graduation Year	2000
	Individual professional's medical school graduation year
Primary Specialty	OPHTHALMOLOGY
	Primary medical specialty reported by the individual professional in the selected enrollment

Practice Information
Line 1 Street Address	111 HIGH TIDE DR
	Group Practice or individual's line 1 address
City	BEAUFORT
	Group Practice or individual's city
State	SC
	Group Practice or individual's state
Zip Code	299065221
	Group Practice or individual's zip code (9 digits when available)

Hospital(s) Affiliation Information
Hospital Affiliation CCN 1	420067
	Medicare CCN of hospital where individual professional provides service 1
Hospital Affiliation LBN 1	BEAUFORT COUNTY MEMORIAL HOSPITAL
	Legal business name of hospital where individual professional provides service 1
Professional Accepts Medicare Assignment	Y