Physician Compare National (NPI:1417042979)

HEALTHCARE PROVIDER: CHARLES D BORUM 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	1417042979
	Unique healthcare provider (clinician) ID assigned by NPPES
PECOS UID	0244383768
	Unique individual clinician ID assigned by PECOS
Professional Enrollment ID	I20111221000263
	Unique ID for the individual professional enrollment that is the source for the data in the observation
Provider Last Name	BORUM
	Individual professional last name
Provider First Name	CHARLES
	Individual professional first name
Provider Middle Name	D
	Individual professional middle name
Provider Gender	M
	The provider's gender if the provider is a person.

Medical School Information
Medical School Name	UNIVERSITY OF MISSISSIPPI SCHOOL OF MEDICINE
	Individual professional's medical school
Graduation Year	1983
	Individual professional's medical school graduation year
Primary Specialty	FAMILY MEDICINE
	Primary medical specialty reported by the individual professional in the selected enrollment

Practice Information
Line 1 Street Address	131 JEFFERSON DAVIS BLVD
	Group Practice or individual's line 1 address
Line 2 Street Address	SUITE F
	Group Practice or individual's line 2 address
City	NATCHEZ
	Group Practice or individual's city
State	MS
	Group Practice or individual's state
Zip Code	391205143
	Group Practice or individual's zip code (9 digits when available)
Phone Number	6014420200
	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	250084
	Medicare CCN of hospital where individual professional provides service 1
Hospital Affiliation LBN 1	MERIT HEALTH NATCHEZ
	Legal business name of hospital where individual professional provides service 1
Hospital Affiliation CCN 2	191318
	Medicare CCN of hospital where individual professional provides service 2
Hospital Affiliation LBN 2	RIVERLAND MEDICAL CENTER
	Legal business name of hospital where individual professional provides service 2
Professional Accepts Medicare Assignment	Y