Physician Compare National (NPI:1528250966)

HEALTHCARE PROVIDER: MANISH P GUPTA 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	1528250966
	Unique healthcare provider (clinician) ID assigned by NPPES
PECOS UID	9234287053
	Unique individual clinician ID assigned by PECOS
Professional Enrollment ID	I20120703000414
	Unique ID for the individual professional enrollment that is the source for the data in the observation
Provider Last Name	GUPTA
	Individual professional last name
Provider First Name	MANISH
	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	1996
	Individual professional's medical school graduation year
Primary Specialty	CARDIOVASCULAR DISEASE (CARDIOLOGY)
	Primary medical specialty reported by the individual professional in the selected enrollment

Practice Information
Line 1 Street Address	10170 W TROPICANA AVE
	Group Practice or individual's line 1 address
Line 2 Street Address	SUITE 156 306
	Group Practice or individual's line 2 address
City	LAS VEGAS
	Group Practice or individual's city
State	NV
	Group Practice or individual's state
Zip Code	891478465
	Group Practice or individual's zip code (9 digits when available)

Hospital(s) Affiliation Information
Hospital Affiliation CCN 1	290053
	Medicare CCN of hospital where individual professional provides service 1
Hospital Affiliation LBN 1	ST ROSE DOMINICAN HOSPITALS - SAN MARTIN CAMPUS
	Legal business name of hospital where individual professional provides service 1
Hospital Affiliation CCN 2	290045
	Medicare CCN of hospital where individual professional provides service 2
Hospital Affiliation LBN 2	ST ROSE DOMINICAN HOSPITALS - SIENA CAMPUS
	Legal business name of hospital where individual professional provides service 2
Hospital Affiliation CCN 3	290021
	Medicare CCN of hospital where individual professional provides service 3
Hospital Affiliation LBN 3	VALLEY HOSPITAL MEDICAL CENTER
	Legal business name of hospital where individual professional provides service 3
Hospital Affiliation CCN 4	290046
	Medicare CCN of hospital where individual professional provides service 4
Hospital Affiliation LBN 4	SPRING VALLEY HOSPITAL MEDICAL CENTER
	Legal business name of hospital where individual professional provides service 4
Hospital Affiliation CCN 5	290058
	Medicare CCN of hospital where individual professional provides service 5
Hospital Affiliation LBN 5	DIGNITY HEALTH ST ROSE DOMINICAN-NORTH LAS VEGAS CAMPUS
	Legal business name of hospital where individual professional provides service 5
Professional Accepts Medicare Assignment	Y

Physician Compare National (NPI:1528250966)

HEALTHCARE PROVIDER: MANISH P GUPTA M.D.

Individual Professional Information

Medical School Information

Practice Information

Hospital(s) Affiliation Information