Physician Compare National (NPI:1306837521)

HEALTHCARE PROVIDER: ALAN RUSS GOTTLIEB MD

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

Individual Professional Information
NPI	1306837521
	Unique healthcare provider (clinician) ID assigned by NPPES
PECOS UID	6406946383
	Unique individual clinician ID assigned by PECOS
Professional Enrollment ID	I20080721000415
	Unique ID for the individual professional enrollment that is the source for the data in the observation
Provider Last Name	GOTTLIEB
	Individual professional last name
Provider First Name	ALAN
	Individual professional first name
Provider Gender	M
	The provider's gender if the provider is a person.

Medical School Information
Medical School Name	UNIVERSITY OF MICHIGAN MEDICAL SCHOOL
	Individual professional's medical school
Graduation Year	1978
	Individual professional's medical school graduation year
Primary Specialty	FAMILY MEDICINE
	Primary medical specialty reported by the individual professional in the selected enrollment
Secondary Specialty 1	EMERGENCY MEDICINE
	First secondary medical specialty reported by the individual professional in the selected enrollment
All Secondary Specialties	EMERGENCY MEDICINE
	All four secondary specialties reported by the individual professional in the selected enrollment, separated by commas

Practice Information
Organization Legal Name	STAT MED PC A CALIFORNIA MEDICAL PROFESSIONAL CORPORATION
	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	1850528530
	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	16
	Total number of individual professionals affiliated with the Group Practice based on Group Practice PAC ID
Line 1 Street Address	970 DEWING AVE
	Group Practice or individual's line 1 address
Line 2 Street Address	SUITE 100B
	Group Practice or individual's line 2 address
City	LAFAYETTE
	Group Practice or individual's city
State	CA
	Group Practice or individual's state
Zip Code	945494291
	Group Practice or individual's zip code (9 digits when available)
Phone Number	9252976396
	Phone number is listed only when there is a single phone number available for the practice location address

Hospital(s) Affiliation Information
Professional Accepts Medicare Assignment	Y