Physician Compare National (NPI:1336251446)

HEALTHCARE PROVIDER: MARK GRANT SHAPIRO 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	1336251446
	Unique healthcare provider (clinician) ID assigned by NPPES
PECOS UID	1850491168
	Unique individual clinician ID assigned by PECOS
Professional Enrollment ID	I20070714000254
	Unique ID for the individual professional enrollment that is the source for the data in the observation
Provider Last Name	SHAPIRO
	Individual professional last name
Provider First Name	MARK
	Individual professional first name
Provider Middle Name	GRANT
	Individual professional middle name
Provider Gender	M
	The provider's gender if the provider is a person.

Medical School Information
Medical School Name	BAYLOR COLLEGE OF MEDICINE
	Individual professional's medical school
Graduation Year	2003
	Individual professional's medical school graduation year
Primary Specialty	INTERNAL MEDICINE
	Primary medical specialty reported by the individual professional in the selected enrollment
Secondary Specialty 1	HOSPITALIST
	First secondary medical specialty reported by the individual professional in the selected enrollment
All Secondary Specialties	HOSPITALIST
	All four secondary specialties reported by the individual professional in the selected enrollment, separated by commas

Practice Information
Organization Legal Name	ST JOSEPH HERITAGE HEALTHCARE
	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	8921993205
	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	1073
	Total number of individual professionals affiliated with the Group Practice based on Group Practice PAC ID
Line 1 Street Address	1165 MONTGOMERY DR
	Group Practice or individual's line 1 address
City	SANTA ROSA
	Group Practice or individual's city
State	CA
	Group Practice or individual's state
Zip Code	954054801
	Group Practice or individual's zip code (9 digits when available)

Hospital(s) Affiliation Information
Hospital Affiliation CCN 1	050174
	Medicare CCN of hospital where individual professional provides service 1
Hospital Affiliation LBN 1	SANTA ROSA MEMORIAL HOSPITAL
	Legal business name of hospital where individual professional provides service 1
Professional Accepts Medicare Assignment	Y