Physician Compare National (NPI:1578540761)

HEALTHCARE PROVIDER: BRIAN DOUGLAS 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	1578540761
	Unique healthcare provider (clinician) ID assigned by NPPES
PECOS UID	2769661651
	Unique individual clinician ID assigned by PECOS
Professional Enrollment ID	I20110125000240
	Unique ID for the individual professional enrollment that is the source for the data in the observation
Provider Last Name	DOUGLAS
	Individual professional last name
Provider First Name	BRIAN
	Individual professional first name
Provider Middle Name	C
	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	1974
	Individual professional's medical school graduation year
Primary Specialty	GASTROENTEROLOGY
	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
Line 1 Street Address	6624 FANNIN ST
	Group Practice or individual's line 1 address
Line 2 Street Address	SUITE 2560
	Group Practice or individual's line 2 address
City	HOUSTON
	Group Practice or individual's city
State	TX
	Group Practice or individual's state
Zip Code	770302310
	Group Practice or individual's zip code (9 digits when available)

Hospital(s) Affiliation Information
Hospital Affiliation CCN 1	450193
	Medicare CCN of hospital where individual professional provides service 1
Hospital Affiliation LBN 1	CHI BAYLOR ST LUKES MEDICAL CENTER
	Legal business name of hospital where individual professional provides service 1
Professional Accepts Medicare Assignment	Y