Physician Compare National (NPI:1386773604)

HEALTHCARE PROVIDER: PREECHA TAWJAREON 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	1386773604
	Unique healthcare provider (clinician) ID assigned by NPPES
PECOS UID	1557441086
	Unique individual clinician ID assigned by PECOS
Professional Enrollment ID	I20080109000354
	Unique ID for the individual professional enrollment that is the source for the data in the observation
Provider Last Name	TAWJAREON
	Individual professional last name
Provider First Name	PREECHA
	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	1968
	Individual professional's medical school graduation year
Primary Specialty	DIAGNOSTIC RADIOLOGY
	Primary medical specialty reported by the individual professional in the selected enrollment

Practice Information
Line 1 Street Address	1201 RICKER RD
	Group Practice or individual's line 1 address
City	SALEM
	Group Practice or individual's city
State	IL
	Group Practice or individual's state
Zip Code	628814263
	Group Practice or individual's zip code (9 digits when available)

Hospital(s) Affiliation Information
Hospital Affiliation CCN 1	141345
	Medicare CCN of hospital where individual professional provides service 1
Hospital Affiliation LBN 1	SALEM TOWNSHIP HOSPITAL
	Legal business name of hospital where individual professional provides service 1
Hospital Affiliation CCN 2	140046
	Medicare CCN of hospital where individual professional provides service 2
Hospital Affiliation LBN 2	SSM HEALTH - GOOD SAMARITAN HOSPITAL
	Legal business name of hospital where individual professional provides service 2
Hospital Affiliation CCN 3	140034
	Medicare CCN of hospital where individual professional provides service 3
Hospital Affiliation LBN 3	SSM HEALTH ST MARY'S HOSPITAL -CENTRALIA
	Legal business name of hospital where individual professional provides service 3
Hospital Affiliation CCN 4	140053
	Medicare CCN of hospital where individual professional provides service 4
Hospital Affiliation LBN 4	ST JOHNS HOSPITAL
	Legal business name of hospital where individual professional provides service 4
Hospital Affiliation CCN 5	260105
	Medicare CCN of hospital where individual professional provides service 5
Hospital Affiliation LBN 5	ST LOUIS UNIVERSITY HOSPITAL
	Legal business name of hospital where individual professional provides service 5
Professional Accepts Medicare Assignment	Y

Physician Compare National (NPI:1386773604)

HEALTHCARE PROVIDER: PREECHA TAWJAREON M.D.

Individual Professional Information

Medical School Information

Practice Information

Hospital(s) Affiliation Information