Physician Compare National (NPI:1467569681)

HEALTHCARE PROVIDER: MANMOHAN GUPTA 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	1467569681
	Unique healthcare provider (clinician) ID assigned by NPPES
PECOS UID	4587815949
	Unique individual clinician ID assigned by PECOS
Professional Enrollment ID	I20121112000289
	Unique ID for the individual professional enrollment that is the source for the data in the observation
Provider Last Name	GUPTA
	Individual professional last name
Provider First Name	MANMOHAN
	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	1972
	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
Line 1 Street Address	770 PINE ST
	Group Practice or individual's line 1 address
Line 2 Street Address	SUITE 440
	Group Practice or individual's line 2 address
City	MACON
	Group Practice or individual's city
State	GA
	Group Practice or individual's state
Zip Code	312012158
	Group Practice or individual's zip code (9 digits when available)

Hospital(s) Affiliation Information
Hospital Affiliation CCN 1	110107
	Medicare CCN of hospital where individual professional provides service 1
Hospital Affiliation LBN 1	MEDICAL CENTER, NAVICENT HEALTH (THE)
	Legal business name of hospital where individual professional provides service 1
Professional Accepts Medicare Assignment	Y