Physician Compare National (NPI:1528205515)

HEALTHCARE PROVIDER: FAHAD F. BAFAKIH 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	1528205515
	Unique healthcare provider (clinician) ID assigned by NPPES
PECOS UID	5991932766
	Unique individual clinician ID assigned by PECOS
Professional Enrollment ID	I20150804005105
	Unique ID for the individual professional enrollment that is the source for the data in the observation
Provider Last Name	BAFAKIH
	Individual professional last name
Provider First Name	FAHAD
	Individual professional first name
Provider Middle Name	FUAD
	Individual professional middle 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	2004
	Individual professional's medical school graduation year
Primary Specialty	PATHOLOGY
	Primary medical specialty reported by the individual professional in the selected enrollment

Practice Information
Line 1 Street Address	20 HOSPITAL DR
	Group Practice or individual's line 1 address
City	LOGAN
	Group Practice or individual's city
State	WV
	Group Practice or individual's state
Zip Code	256013452
	Group Practice or individual's zip code (9 digits when available)

Hospital(s) Affiliation Information
Hospital Affiliation CCN 1	510048
	Medicare CCN of hospital where individual professional provides service 1
Hospital Affiliation LBN 1	LOGAN REGIONAL MEDICAL CENTER
	Legal business name of hospital where individual professional provides service 1
Professional Accepts Medicare Assignment	Y