Physician Compare National (NPI:1366837239)

HEALTHCARE PROVIDER: KENECHUKWU NWAGBARA 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	1366837239
	Unique healthcare provider (clinician) ID assigned by NPPES
PECOS UID	9537416128
	Unique individual clinician ID assigned by PECOS
Professional Enrollment ID	I20200528002264
	Unique ID for the individual professional enrollment that is the source for the data in the observation
Provider Last Name	NWAGBARA
	Individual professional last name
Provider First Name	KENECHUKWU
	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	SOUTHERN REGIONAL PHYSICIANS MANAGEMENT GROUP, 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	9032491956
	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	42
	Total number of individual professionals affiliated with the Group Practice based on Group Practice PAC ID
Line 1 Street Address	11 UPPER RIVERDALE RD SW
	Group Practice or individual's line 1 address
City	RIVERDALE
	Group Practice or individual's city
State	GA
	Group Practice or individual's state
Zip Code	302742615
	Group Practice or individual's zip code (9 digits when available)
Phone Number	7708977277
	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	260001
	Medicare CCN of hospital where individual professional provides service 1
Hospital Affiliation LBN 1	MERCY HOSPITAL JOPLIN
	Legal business name of hospital where individual professional provides service 1
Hospital Affiliation CCN 2	110165
	Medicare CCN of hospital where individual professional provides service 2
Hospital Affiliation LBN 2	SOUTHERN REGIONAL MEDICAL CENTER
	Legal business name of hospital where individual professional provides service 2
Hospital Affiliation CCN 3	260065
	Medicare CCN of hospital where individual professional provides service 3
Hospital Affiliation LBN 3	MERCY HOSPITAL SPRINGFIELD
	Legal business name of hospital where individual professional provides service 3
Professional Accepts Medicare Assignment	Y