Physician Compare National (NPI:1487629614)

HEALTHCARE PROVIDER: SERGEY GRACHEV 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	1487629614
	Unique healthcare provider (clinician) ID assigned by NPPES
PECOS UID	1658398490
	Unique individual clinician ID assigned by PECOS
Professional Enrollment ID	I20060111000716
	Unique ID for the individual professional enrollment that is the source for the data in the observation
Provider Last Name	GRACHEV
	Individual professional last name
Provider First Name	SERGEY
	Individual professional first name
Provider Gender	M
	The provider's gender if the provider is a person.
Provider Credential Text	MD
	The abbreviations for professional degrees or credentials used or held by the provider, if the provider is an individual. Examples are MD, DDS, CSW, CNA, AA, NP, RNA, or PSY. These credential designations will not be verified by NPS.

Medical School Information
Medical School Name	OTHER
	Individual professional's medical school
Graduation Year	1980
	Individual professional's medical school graduation year
Primary Specialty	GENERAL SURGERY
	Primary medical specialty reported by the individual professional in the selected enrollment

Practice Information
Line 1 Street Address	115 E BAY AVE
	Group Practice or individual's line 1 address
City	MANAHAWKIN
	Group Practice or individual's city
State	NJ
	Group Practice or individual's state
Zip Code	080503109
	Group Practice or individual's zip code (9 digits when available)

Hospital(s) Affiliation Information
Hospital Affiliation CCN 1	310113
	Medicare CCN of hospital where individual professional provides service 1
Hospital Affiliation LBN 1	SOUTHERN OCEAN MEDICAL CENTER
	Legal business name of hospital where individual professional provides service 1
Hospital Affiliation CCN 2	310041
	Medicare CCN of hospital where individual professional provides service 2
Hospital Affiliation LBN 2	COMMUNITY MEDICAL CENTER
	Legal business name of hospital where individual professional provides service 2
Professional Accepts Medicare Assignment	Y