Physician Compare National (NPI:1609195643)

HEALTHCARE PROVIDER: PRATHEEK SIMON KAKKASSERIL 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	1609195643
	Unique healthcare provider (clinician) ID assigned by NPPES
PECOS UID	0143474247
	Unique individual clinician ID assigned by PECOS
Professional Enrollment ID	I20130124000440
	Unique ID for the individual professional enrollment that is the source for the data in the observation
Provider Last Name	KAKKASSERIL
	Individual professional last name
Provider First Name	PRATHEEK
	Individual professional first name
Provider Gender	M
	The provider's gender if the provider is a person.

Medical School Information
Medical School Name	NORTHEASTERN OHIO UNIVERSITY COLLEGE OF MEDICINE
	Individual professional's medical school
Graduation Year	2005
	Individual professional's medical school graduation year
Primary Specialty	VASCULAR SURGERY
	Primary medical specialty reported by the individual professional in the selected enrollment

Practice Information
Organization Legal Name	MERCY HEALTH PHYSICIANS YOUNGSTOWN, LLC
	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	9234318270
	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	367
	Total number of individual professionals affiliated with the Group Practice based on Group Practice PAC ID
Line 1 Street Address	8401 MARKET ST
	Group Practice or individual's line 1 address
City	BOARDMAN
	Group Practice or individual's city
State	OH
	Group Practice or individual's state
Zip Code	445126725
	Group Practice or individual's zip code (9 digits when available)

Hospital(s) Affiliation Information
Hospital Affiliation CCN 1	360064
	Medicare CCN of hospital where individual professional provides service 1
Hospital Affiliation LBN 1	ST ELIZABETH YOUNGSTOWN HOSPITAL
	Legal business name of hospital where individual professional provides service 1
Hospital Affiliation CCN 2	360276
	Medicare CCN of hospital where individual professional provides service 2
Hospital Affiliation LBN 2	HMHP ST ELIZABETH BOARDMAN HEALTH CENTER
	Legal business name of hospital where individual professional provides service 2
Hospital Affiliation CCN 3	360161
	Medicare CCN of hospital where individual professional provides service 3
Hospital Affiliation LBN 3	ST JOSEPH WARREN HOSPITAL
	Legal business name of hospital where individual professional provides service 3
Professional Accepts Medicare Assignment	Y