Physician Compare National (NPI:1508069659)

HEALTHCARE PROVIDER: VIDYA MATHIVANAN MD

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

Individual Professional Information
NPI	1508069659
	Unique healthcare provider (clinician) ID assigned by NPPES
PECOS UID	6507903598
	Unique individual clinician ID assigned by PECOS
Professional Enrollment ID	I20091023000320
	Unique ID for the individual professional enrollment that is the source for the data in the observation
Provider Last Name	MATHIVANAN
	Individual professional last name
Provider First Name	VIDYA
	Individual professional first name
Provider Gender	F
	The provider's gender if the provider is a person.

Medical School Information
Medical School Name	OTHER
	Individual professional's medical school
Graduation Year	1998
	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	1550 1ST COLONY BLVD
	Group Practice or individual's line 1 address
City	SUGAR LAND
	Group Practice or individual's city
State	TX
	Group Practice or individual's state
Zip Code	774794000
	Group Practice or individual's zip code (9 digits when available)

Hospital(s) Affiliation Information
Hospital Affiliation CCN 1	450184
	Medicare CCN of hospital where individual professional provides service 1
Hospital Affiliation LBN 1	MEMORIAL HERMANN HOSPITAL SYSTEM
	Legal business name of hospital where individual professional provides service 1
Hospital Affiliation CCN 2	450820
	Medicare CCN of hospital where individual professional provides service 2
Hospital Affiliation LBN 2	HOUSTON METHODIST SUGARLAND HOSPITAL
	Legal business name of hospital where individual professional provides service 2
Hospital Affiliation CCN 3	670053
	Medicare CCN of hospital where individual professional provides service 3
Hospital Affiliation LBN 3	CHI ST LUKES HEALTH - SUGAR LAND HOSPITAL
	Legal business name of hospital where individual professional provides service 3
Professional Accepts Medicare Assignment	Y