Physician Compare National (NPI:1306181375)

HEALTHCARE PROVIDER: SIMPLEDEEP BANIPAL 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	1306181375
	Unique healthcare provider (clinician) ID assigned by NPPES
PECOS UID	5395036529
	Unique individual clinician ID assigned by PECOS
Professional Enrollment ID	I20180815003413
	Unique ID for the individual professional enrollment that is the source for the data in the observation
Provider Last Name	BANIPAL
	Individual professional last name
Provider First Name	SIMPLEDEEP
	Individual professional first name
Provider Middle Name	KAUR
	Individual professional middle name
Provider Gender	F
	The provider's gender if the provider is a person.

Medical School Information
Medical School Name	TEMPLE UNIVERSITY SCHOOL OF MEDICINE
	Individual professional's medical school
Graduation Year	2010
	Individual professional's medical school graduation year
Primary Specialty	VASCULAR SURGERY
	Primary medical specialty reported by the individual professional in the selected enrollment

Practice Information
Line 1 Street Address	355 E 21ST ST
	Group Practice or individual's line 1 address
Line 2 Street Address	SUITE C
	Group Practice or individual's line 2 address
City	SAN BERNARDINO
	Group Practice or individual's city
State	CA
	Group Practice or individual's state
Zip Code	924044851
	Group Practice or individual's zip code (9 digits when available)

Hospital(s) Affiliation Information
Hospital Affiliation CCN 1	050129
	Medicare CCN of hospital where individual professional provides service 1
Hospital Affiliation LBN 1	ST BERNARDINE MEDICAL CENTER
	Legal business name of hospital where individual professional provides service 1
Hospital Affiliation CCN 2	050300
	Medicare CCN of hospital where individual professional provides service 2
Hospital Affiliation LBN 2	ST MARY MEDICAL CENTER
	Legal business name of hospital where individual professional provides service 2
Hospital Affiliation CCN 3	050272
	Medicare CCN of hospital where individual professional provides service 3
Hospital Affiliation LBN 3	REDLANDS COMMUNITY HOSPITAL
	Legal business name of hospital where individual professional provides service 3
Professional Accepts Medicare Assignment	Y