Physician Compare National (NPI:1568535615)

HEALTHCARE PROVIDER: JYOTI S DATTA 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	1568535615
	Unique healthcare provider (clinician) ID assigned by NPPES
PECOS UID	8527225762
	Unique individual clinician ID assigned by PECOS
Professional Enrollment ID	I20120131000514
	Unique ID for the individual professional enrollment that is the source for the data in the observation
Provider Last Name	DATTA
	Individual professional last name
Provider First Name	JYOTI
	Individual professional first name
Provider Middle Name	SARUP
	Individual professional middle name
Provider Gender	M
	The provider's gender if the provider is a person.

Medical School Information
Medical School Name	UNIVERSITY OF MISSOURI, COLUMBIA SCHOOL OF MEDICINE
	Individual professional's medical school
Primary Specialty	INTERNAL MEDICINE
	Primary medical specialty reported by the individual professional in the selected enrollment
Secondary Specialty 1	PULMONARY DISEASE
	First secondary medical specialty reported by the individual professional in the selected enrollment
All Secondary Specialties	PULMONARY DISEASE
	All four secondary specialties reported by the individual professional in the selected enrollment, separated by commas

Practice Information
Line 1 Street Address	1045 ATLANTIC AVE
	Group Practice or individual's line 1 address
Line 2 Street Address	SUITE 616
	Group Practice or individual's line 2 address
City	LONG BEACH
	Group Practice or individual's city
State	CA
	Group Practice or individual's state
Zip Code	908133411
	Group Practice or individual's zip code (9 digits when available)

Hospital(s) Affiliation Information
Hospital Affiliation CCN 1	050191
	Medicare CCN of hospital where individual professional provides service 1
Hospital Affiliation LBN 1	ST MARY MEDICAL CENTER
	Legal business name of hospital where individual professional provides service 1
Professional Accepts Medicare Assignment	Y