Physician Compare National (NPI:1457895179)

HEALTHCARE PROVIDER: SHANAH GAVIA

Physician Compare National contains general information about individual eligible professionals (EPs) such as demographic information and Medicare quality program participation.

Individual Professional Information
NPI	1457895179
	Unique healthcare provider (clinician) ID assigned by NPPES
PECOS UID	3375967813
	Unique individual clinician ID assigned by PECOS
Professional Enrollment ID	I20200716003713
	Unique ID for the individual professional enrollment that is the source for the data in the observation
Provider Last Name	GAVIA
	Individual professional last name
Provider First Name	SHANAH
	Individual professional first name
Provider Gender	F
	The provider's gender if the provider is a person.

Medical School Information
Medical School Name	UNIVERSITY OF ALABAMA SCHOOL OF DENTISTRY
	Individual professional's medical school
Graduation Year	2000
	Individual professional's medical school graduation year
Primary Specialty	PHYSICIAN ASSISTANT
	Primary medical specialty reported by the individual professional in the selected enrollment

Practice Information
Organization Legal Name	DOUGLAS G HAMILTON MEDICAL CORP
	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	4688852528
	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	2
	Total number of individual professionals affiliated with the Group Practice based on Group Practice PAC ID
Line 1 Street Address	6325 TOPANGA CANYON BLVD
	Group Practice or individual's line 1 address
Line 2 Street Address	SUITE 301
	Group Practice or individual's line 2 address
City	WOODLAND HILLS
	Group Practice or individual's city
State	CA
	Group Practice or individual's state
Zip Code	913672029
	Group Practice or individual's zip code (9 digits when available)
Phone Number	8188847150
	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