Physician Compare National (NPI:1629056692)

HEALTHCARE PROVIDER: MEHRDAD REZAEE MD PHD

Physician Compare National contains general information about individual eligible professionals (EPs) such as demographic information and Medicare quality program participation.

Individual Professional Information
NPI	1629056692
	Unique healthcare provider (clinician) ID assigned by NPPES
PECOS UID	2365491669
	Unique individual clinician ID assigned by PECOS
Professional Enrollment ID	I20050113000419
	Unique ID for the individual professional enrollment that is the source for the data in the observation
Provider Last Name	REZAEE
	Individual professional last name
Provider First Name	MEHRDAD
	Individual professional first 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	MEDICAL COLLEGE OF WISCONSIN
	Individual professional's medical school
Graduation Year	1994
	Individual professional's medical school graduation year
Primary Specialty	CARDIOVASCULAR DISEASE (CARDIOLOGY)
	Primary medical specialty reported by the individual professional in the selected enrollment
Secondary Specialty 1	INTERVENTIONAL CARDIOLOGY
	First secondary medical specialty reported by the individual professional in the selected enrollment
Secondary Specialty 2	PERIPHERAL VASCULAR DISEASE
	Second secondary medical specialty reported by the individual professional in the selected enrollment
All Secondary Specialties	INTERVENTIONAL CARDIOLOGY, PERIPHERAL VASCULAR DISEASE
	All four secondary specialties reported by the individual professional in the selected enrollment, separated by commas

Practice Information
Line 1 Street Address	2030 FOREST AVE
	Group Practice or individual's line 1 address
Line 2 Street Address	SUITE 210
	Group Practice or individual's line 2 address
City	SAN JOSE
	Group Practice or individual's city
State	CA
	Group Practice or individual's state
Zip Code	951284833
	Group Practice or individual's zip code (9 digits when available)

Hospital(s) Affiliation Information
Hospital Affiliation CCN 1	050038
	Medicare CCN of hospital where individual professional provides service 1
Hospital Affiliation LBN 1	SANTA CLARA VALLEY MEDICAL CENTER
	Legal business name of hospital where individual professional provides service 1
Professional Accepts Medicare Assignment	Y