Physician Compare National (NPI:1487817854)

HEALTHCARE PROVIDER: JEAN CLAUDE BASSILA 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	1487817854
	Unique healthcare provider (clinician) ID assigned by NPPES
PECOS UID	6204065220
	Unique individual clinician ID assigned by PECOS
Professional Enrollment ID	I20180627000513
	Unique ID for the individual professional enrollment that is the source for the data in the observation
Provider Last Name	BASSILA
	Individual professional last name
Provider First Name	JEAN CLAUDE
	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	2006
	Individual professional's medical school graduation year
Primary Specialty	NEPHROLOGY
	Primary medical specialty reported by the individual professional in the selected enrollment
Secondary Specialty 1	INTERNAL MEDICINE
	First secondary medical specialty reported by the individual professional in the selected enrollment
All Secondary Specialties	INTERNAL MEDICINE
	All four secondary specialties reported by the individual professional in the selected enrollment, separated by commas

Practice Information
Line 1 Street Address	435 DOYLE PARK DR
	Group Practice or individual's line 1 address
City	SANTA ROSA
	Group Practice or individual's city
State	CA
	Group Practice or individual's state
Zip Code	954054515
	Group Practice or individual's zip code (9 digits when available)

Hospital(s) Affiliation Information
Hospital Affiliation CCN 1	050174
	Medicare CCN of hospital where individual professional provides service 1
Hospital Affiliation LBN 1	SANTA ROSA MEMORIAL HOSPITAL
	Legal business name of hospital where individual professional provides service 1
Hospital Affiliation CCN 2	050301
	Medicare CCN of hospital where individual professional provides service 2
Hospital Affiliation LBN 2	ADVENTIST HEALTH UKIAH VALLEY
	Legal business name of hospital where individual professional provides service 2
Hospital Affiliation CCN 3	051321
	Medicare CCN of hospital where individual professional provides service 3
Hospital Affiliation LBN 3	HEALDSBURG DISTRICT HOSPITAL
	Legal business name of hospital where individual professional provides service 3
Hospital Affiliation CCN 4	051329
	Medicare CCN of hospital where individual professional provides service 4
Hospital Affiliation LBN 4	SUTTER LAKESIDE HOSPITAL
	Legal business name of hospital where individual professional provides service 4
Hospital Affiliation CCN 5	050136
	Medicare CCN of hospital where individual professional provides service 5
Hospital Affiliation LBN 5	PETALUMA VALLEY HOSPITAL
	Legal business name of hospital where individual professional provides service 5
Professional Accepts Medicare Assignment	Y

Physician Compare National (NPI:1487817854)

HEALTHCARE PROVIDER: JEAN CLAUDE BASSILA M.D.

Individual Professional Information

Medical School Information

Practice Information

Hospital(s) Affiliation Information