Physician Compare National (NPI:1306263306)

HEALTHCARE PROVIDER: AHMAD MOSSA-BASHA DO

Physician Compare National contains general information about individual eligible professionals (EPs) such as demographic information and Medicare quality program participation.

Individual Professional Information
NPI	1306263306
	Unique healthcare provider (clinician) ID assigned by NPPES
PECOS UID	8921317322
	Unique individual clinician ID assigned by PECOS
Professional Enrollment ID	I20170727002505
	Unique ID for the individual professional enrollment that is the source for the data in the observation
Provider Last Name	MOSSA-BASHA
	Individual professional last name
Provider First Name	AHMAD
	Individual professional first name
Provider Gender	M
	The provider's gender if the provider is a person.

Medical School Information
Medical School Name	MICHIGAN STATE UNIVERSITY COLLEGE OF OSTEOPATHIC MEDICINE
	Individual professional's medical school
Graduation Year	2014
	Individual professional's medical school graduation year
Primary Specialty	INTERNAL MEDICINE
	Primary medical specialty reported by the individual professional in the selected enrollment

Practice Information
Organization Legal Name	COMMUNITY PHYSICIANS OF INDIANA INC
	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	1759416662
	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	1069
	Total number of individual professionals affiliated with the Group Practice based on Group Practice PAC ID
Line 1 Street Address	1515 N MADISON AVE
	Group Practice or individual's line 1 address
Line 2 Street Address	COMMUNITY HOSPITAL ANDERSON
	Group Practice or individual's line 2 address
City	ANDERSON
	Group Practice or individual's city
State	IN
	Group Practice or individual's state
Zip Code	460113457
	Group Practice or individual's zip code (9 digits when available)
Phone Number	7652964242
	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	150113
	Medicare CCN of hospital where individual professional provides service 1
Hospital Affiliation LBN 1	COMMUNITY HOSPITAL OF ANDERSON AND MADISON COUNTY
	Legal business name of hospital where individual professional provides service 1
Hospital Affiliation CCN 2	150059
	Medicare CCN of hospital where individual professional provides service 2
Hospital Affiliation LBN 2	RIVERVIEW HEALTH
	Legal business name of hospital where individual professional provides service 2
Professional Accepts Medicare Assignment	Y