Physician Compare National (NPI:1306112057)

HEALTHCARE PROVIDER: ANTHONY SAMIR TADROS 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	1306112057
	Unique healthcare provider (clinician) ID assigned by NPPES
PECOS UID	5698045797
	Unique individual clinician ID assigned by PECOS
Professional Enrollment ID	I20170724000403
	Unique ID for the individual professional enrollment that is the source for the data in the observation
Provider Last Name	TADROS
	Individual professional last name
Provider First Name	ANTHONY
	Individual professional first name
Provider Middle Name	S
	Individual professional middle name
Provider Gender	M
	The provider's gender if the provider is a person.

Medical School Information
Medical School Name	UNIVERSITY OF CALIFORNIA, SAN DIEGO SCHOOL OF MEDICINE
	Individual professional's medical school
Graduation Year	2012
	Individual professional's medical school graduation year
Primary Specialty	DIAGNOSTIC RADIOLOGY
	Primary medical specialty reported by the individual professional in the selected enrollment

Practice Information
Organization Legal Name	REGENTS OF THE UNIVESITY OF CALIFORNIA - UCSD MEDICAL GROUP
	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	3577476761
	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	1352
	Total number of individual professionals affiliated with the Group Practice based on Group Practice PAC ID
Line 1 Street Address	200 W ARBOR DR
	Group Practice or individual's line 1 address
City	SAN DIEGO
	Group Practice or individual's city
State	CA
	Group Practice or individual's state
Zip Code	921031911
	Group Practice or individual's zip code (9 digits when available)
Phone Number	8586577000
	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	230117
	Medicare CCN of hospital where individual professional provides service 1
Hospital Affiliation LBN 1	BORGESS MEDICAL CENTER
	Legal business name of hospital where individual professional provides service 1
Hospital Affiliation CCN 2	050025
	Medicare CCN of hospital where individual professional provides service 2
Hospital Affiliation LBN 2	UC SAN DIEGO HEALTH HILLCREST - HILLCREST MED CTR
	Legal business name of hospital where individual professional provides service 2
Hospital Affiliation CCN 3	230015
	Medicare CCN of hospital where individual professional provides service 3
Hospital Affiliation LBN 3	THREE RIVERS HEALTH
	Legal business name of hospital where individual professional provides service 3
Hospital Affiliation CCN 4	230037
	Medicare CCN of hospital where individual professional provides service 4
Hospital Affiliation LBN 4	HILLSDALE HOSPITAL
	Legal business name of hospital where individual professional provides service 4
Professional Accepts Medicare Assignment	Y