Physician Compare National (NPI:1477660058)

HEALTHCARE PROVIDER: SCOTT G PRUSHIK 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	1477660058
	Unique healthcare provider (clinician) ID assigned by NPPES
PECOS UID	4688830938
	Unique individual clinician ID assigned by PECOS
Professional Enrollment ID	I20120801000009
	Unique ID for the individual professional enrollment that is the source for the data in the observation
Provider Last Name	PRUSHIK
	Individual professional last name
Provider First Name	SCOTT
	Individual professional first name
Provider Middle Name	G
	Individual professional middle name
Provider Gender	M
	The provider's gender if the provider is a person.

Medical School Information
Medical School Name	BOSTON UNIVERSITY SCHOOL OF MEDICINE
	Individual professional's medical school
Graduation Year	2000
	Individual professional's medical school graduation year
Primary Specialty	VASCULAR SURGERY
	Primary medical specialty reported by the individual professional in the selected enrollment

Practice Information
Organization Legal Name	STEWARD MEDICAL GROUP 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	2860688728
	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	1543
	Total number of individual professionals affiliated with the Group Practice based on Group Practice PAC ID
Line 1 Street Address	2110 DORCHESTER AVE
	Group Practice or individual's line 1 address
Line 2 Street Address	SUITE 207
	Group Practice or individual's line 2 address
City	DORCHESTER
	Group Practice or individual's city
State	MA
	Group Practice or individual's state
Zip Code	021245628
	Group Practice or individual's zip code (9 digits when available)
Phone Number	6172964709
	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	220036
	Medicare CCN of hospital where individual professional provides service 1
Hospital Affiliation LBN 1	ST ELIZABETH'S MEDICAL CENTER
	Legal business name of hospital where individual professional provides service 1
Hospital Affiliation CCN 2	220098
	Medicare CCN of hospital where individual professional provides service 2
Hospital Affiliation LBN 2	NASHOBA VALLEY MEDICAL CENTER
	Legal business name of hospital where individual professional provides service 2
Hospital Affiliation CCN 3	220080
	Medicare CCN of hospital where individual professional provides service 3
Hospital Affiliation LBN 3	HOLY FAMILY HOSPITAL
	Legal business name of hospital where individual professional provides service 3
Professional Accepts Medicare Assignment	Y