Physician Compare National (NPI:1588658017)

HEALTHCARE PROVIDER: MUKTIRAJ MEHTA 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	1588658017
	Unique healthcare provider (clinician) ID assigned by NPPES
PECOS UID	8921086315
	Unique individual clinician ID assigned by PECOS
Professional Enrollment ID	I20040712001039
	Unique ID for the individual professional enrollment that is the source for the data in the observation
Provider Last Name	MEHTA
	Individual professional last name
Provider First Name	MUKTIRAJ
	Individual professional first name
Provider Middle Name	B
	Individual professional middle name
Provider Gender	M
	The provider's gender if the provider is a person.
Provider Credential Text	MD
	The abbreviations for professional degrees or credentials used or held by the provider, if the provider is an individual. Examples are MD, DDS, CSW, CNA, AA, NP, RNA, or PSY. These credential designations will not be verified by NPS.

Medical School Information
Medical School Name	OTHER
	Individual professional's medical school
Graduation Year	1973
	Individual professional's medical school graduation year
Primary Specialty	PSYCHIATRY
	Primary medical specialty reported by the individual professional in the selected enrollment

Practice Information
Line 1 Street Address	960 M60
	Group Practice or individual's line 1 address
City	CASSOPOLIS
	Group Practice or individual's city
State	MI
	Group Practice or individual's state
Zip Code	490319339
	Group Practice or individual's zip code (9 digits when available)

Hospital(s) Affiliation Information
Hospital Affiliation CCN 1	230022
	Medicare CCN of hospital where individual professional provides service 1
Hospital Affiliation LBN 1	COMMUNITY HEALTH CENTER OF BRANCH COUNTY
	Legal business name of hospital where individual professional provides service 1
Hospital Affiliation CCN 2	231315
	Medicare CCN of hospital where individual professional provides service 2
Hospital Affiliation LBN 2	BORGESS-LEE MEMORIAL HOSPITAL
	Legal business name of hospital where individual professional provides service 2
Professional Accepts Medicare Assignment	Y