Physician Compare National (NPI:1508207895)

HEALTHCARE PROVIDER: YAZHINI VALLATHARASU 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	1508207895
	Unique healthcare provider (clinician) ID assigned by NPPES
PECOS UID	4385872712
	Unique individual clinician ID assigned by PECOS
Professional Enrollment ID	I20150409001197
	Unique ID for the individual professional enrollment that is the source for the data in the observation
Provider Last Name	VALLATHARASU
	Individual professional last name
Provider First Name	YAZHINI
	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	2012
	Individual professional's medical school graduation year
Primary Specialty	HEMATOLOGY/ONCOLOGY
	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
Organization Legal Name	THEDACARE INCORPORATED
	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	1759294887
	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	449
	Total number of individual professionals affiliated with the Group Practice based on Group Practice PAC ID
Line 1 Street Address	2500 E CAPITAL DR
	Group Practice or individual's line 1 address
City	APPLETON
	Group Practice or individual's city
State	WI
	Group Practice or individual's state
Zip Code	549118735
	Group Practice or individual's zip code (9 digits when available)
Phone Number	9203643600
	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	520160
	Medicare CCN of hospital where individual professional provides service 1
Hospital Affiliation LBN 1	THEDACARE REGIONAL MEDICAL CENTER - APPLETON INC
	Legal business name of hospital where individual professional provides service 1
Hospital Affiliation CCN 2	521326
	Medicare CCN of hospital where individual professional provides service 2
Hospital Affiliation LBN 2	NEW LONDON FAMILY MEDICAL CENTER
	Legal business name of hospital where individual professional provides service 2
Hospital Affiliation CCN 3	520045
	Medicare CCN of hospital where individual professional provides service 3
Hospital Affiliation LBN 3	THEDA CLARK MEDICAL CENTER
	Legal business name of hospital where individual professional provides service 3
Professional Accepts Medicare Assignment	Y