Physician Compare National (NPI:1558340232)

HEALTHCARE PROVIDER: ROGER RANGARAJAN THAYER DMD

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

Individual Professional Information
NPI	1558340232
	Unique healthcare provider (clinician) ID assigned by NPPES
PECOS UID	3678736436
	Unique individual clinician ID assigned by PECOS
Professional Enrollment ID	I20120515000640
	Unique ID for the individual professional enrollment that is the source for the data in the observation
Provider Last Name	THAYER
	Individual professional last name
Provider First Name	ROGER
	Individual professional first name
Provider Middle Name	R
	Individual professional middle name
Provider Gender	M
	The provider's gender if the provider is a person.

Medical School Information
Medical School Name	NOVA SOUTHEASTERN UNIV COLLEGE OF DENTAL MEDICINE
	Individual professional's medical school
Graduation Year	2004
	Individual professional's medical school graduation year
Primary Specialty	ORAL SURGERY
	Primary medical specialty reported by the individual professional in the selected enrollment
Secondary Specialty 1	MAXILLOFACIAL SURGERY
	First secondary medical specialty reported by the individual professional in the selected enrollment
All Secondary Specialties	MAXILLOFACIAL SURGERY
	All four secondary specialties reported by the individual professional in the selected enrollment, separated by commas

Practice Information
Organization Legal Name	FLORIDA ORAL AND FACIAL SURGICAL ASSOCIATES PA
	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	5799699500
	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	4
	Total number of individual professionals affiliated with the Group Practice based on Group Practice PAC ID
Line 1 Street Address	549 HEALTH BLVD
	Group Practice or individual's line 1 address
City	DAYTONA BEACH
	Group Practice or individual's city
State	FL
	Group Practice or individual's state
Zip Code	321141493
	Group Practice or individual's zip code (9 digits when available)
Phone Number	3862526438
	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	100017
	Medicare CCN of hospital where individual professional provides service 1
Hospital Affiliation LBN 1	HALIFAX HEALTH MEDICAL CENTER
	Legal business name of hospital where individual professional provides service 1
Professional Accepts Medicare Assignment	Y