Physician Compare National (NPI:1326331893)

HEALTHCARE PROVIDER: WALLY FOLAD 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	1326331893
	Unique healthcare provider (clinician) ID assigned by NPPES
PECOS UID	8022237841
	Unique individual clinician ID assigned by PECOS
Professional Enrollment ID	I20200413001259
	Unique ID for the individual professional enrollment that is the source for the data in the observation
Provider Last Name	FOLAD
	Individual professional last name
Provider First Name	WALLY
	Individual professional first name
Provider Gender	M
	The provider's gender if the provider is a person.

Medical School Information
Medical School Name	OTHER
	Individual professional's medical school
Graduation Year	2010
	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	GRENADA PHYSICIAN SERVICES, LLC
	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	4284965773
	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	19
	Total number of individual professionals affiliated with the Group Practice based on Group Practice PAC ID
Line 1 Street Address	960 AVENT DR
	Group Practice or individual's line 1 address
City	GRENADA
	Group Practice or individual's city
State	MS
	Group Practice or individual's state
Zip Code	389015230
	Group Practice or individual's zip code (9 digits when available)
Phone Number	6622277000
	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	250168
	Medicare CCN of hospital where individual professional provides service 1
Hospital Affiliation LBN 1	UNIVERSITY OF MISSISSIPPI MEDICAL CENTER- GRENADA
	Legal business name of hospital where individual professional provides service 1
Hospital Affiliation CCN 2	180040
	Medicare CCN of hospital where individual professional provides service 2
Hospital Affiliation LBN 2	JEWISH HOSPITAL & ST MARY'S HEALTHCARE
	Legal business name of hospital where individual professional provides service 2
Hospital Affiliation CCN 3	440029
	Medicare CCN of hospital where individual professional provides service 3
Hospital Affiliation LBN 3	WILLIAMSON MEDICAL CENTER
	Legal business name of hospital where individual professional provides service 3
Professional Accepts Medicare Assignment	Y