Physician Compare National (NPI:1427389691)

HEALTHCARE PROVIDER: SCOTT BRUCE GLADSTONE 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	1427389691
	Unique healthcare provider (clinician) ID assigned by NPPES
PECOS UID	7911321914
	Unique individual clinician ID assigned by PECOS
Professional Enrollment ID	I20200723001666
	Unique ID for the individual professional enrollment that is the source for the data in the observation
Provider Last Name	GLADSTONE
	Individual professional last name
Provider First Name	SCOTT
	Individual professional first name
Provider Middle Name	BRUCE
	Individual professional middle name
Provider Gender	M
	The provider's gender if the provider is a person.

Medical School Information
Medical School Name	HOWARD UNIVERSITY COLLEGE OF MEDICINE
	Individual professional's medical school
Graduation Year	1985
	Individual professional's medical school graduation year
Primary Specialty	PSYCHIATRY
	Primary medical specialty reported by the individual professional in the selected enrollment

Practice Information
Organization Legal Name	EHAB YACOUB MD INC.
	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	5092099523
	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	10
	Total number of individual professionals affiliated with the Group Practice based on Group Practice PAC ID
Line 1 Street Address	1225 W 190TH ST
	Group Practice or individual's line 1 address
Line 2 Street Address	SUITE 280
	Group Practice or individual's line 2 address
City	GARDENA
	Group Practice or individual's city
State	CA
	Group Practice or individual's state
Zip Code	902484305
	Group Practice or individual's zip code (9 digits when available)
Phone Number	3105158113
	Phone number is listed only when there is a single phone number available for the practice location address

Hospital(s) Affiliation Information
Professional Accepts Medicare Assignment	Y