Physician Compare National (NPI:1609881317)

HEALTHCARE PROVIDER: JONATHAN RAPHAEL BLUMBERG 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	1609881317
	Unique healthcare provider (clinician) ID assigned by NPPES
PECOS UID	0143412247
	Unique individual clinician ID assigned by PECOS
Professional Enrollment ID	I20101007000907
	Unique ID for the individual professional enrollment that is the source for the data in the observation
Provider Last Name	BLUMBERG
	Individual professional last name
Provider First Name	JONATHAN
	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	UNIVERSITY OF MASSACHUSETTS MEDICAL SCHOOL
	Individual professional's medical school
Graduation Year	1997
	Individual professional's medical school graduation year
Primary Specialty	INTERNAL MEDICINE
	Primary medical specialty reported by the individual professional in the selected enrollment

Practice Information
Line 1 Street Address	1101 BEACON ST
	Group Practice or individual's line 1 address
Line 2 Street Address	SUITE 2 WEST
	Group Practice or individual's line 2 address
City	BROOKLINE
	Group Practice or individual's city
State	MA
	Group Practice or individual's state
Zip Code	024465587
	Group Practice or individual's zip code (9 digits when available)

Hospital(s) Affiliation Information
Hospital Affiliation CCN 1	220086
	Medicare CCN of hospital where individual professional provides service 1
Hospital Affiliation LBN 1	BETH ISRAEL DEACONESS MEDICAL CENTER
	Legal business name of hospital where individual professional provides service 1
Hospital Affiliation CCN 2	220083
	Medicare CCN of hospital where individual professional provides service 2
Hospital Affiliation LBN 2	BETH ISRAEL DEACONESS HOSPITAL - NEEDHAM
	Legal business name of hospital where individual professional provides service 2
Hospital Affiliation CCN 3	220110
	Medicare CCN of hospital where individual professional provides service 3
Hospital Affiliation LBN 3	BRIGHAM AND WOMEN'S HOSPITAL
	Legal business name of hospital where individual professional provides service 3
Professional Accepts Medicare Assignment	Y