Physician Compare National (NPI:1629077573)

HEALTHCARE PROVIDER: MIRATIQULLAH HESSAMI 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	1629077573
	Unique healthcare provider (clinician) ID assigned by NPPES
PECOS UID	1355473208
	Unique individual clinician ID assigned by PECOS
Professional Enrollment ID	I20100713000529
	Unique ID for the individual professional enrollment that is the source for the data in the observation
Provider Last Name	HESSAMI
	Individual professional last name
Provider First Name	MIRATIQULLAH
	Individual professional first 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	1991
	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	E DIXIE AVE
	Group Practice or individual's line 1 address
City	LEESBURG
	Group Practice or individual's city
State	FL
	Group Practice or individual's state
Zip Code	34748
	Group Practice or individual's zip code (9 digits when available)

Hospital(s) Affiliation Information
Hospital Affiliation CCN 1	100084
	Medicare CCN of hospital where individual professional provides service 1
Hospital Affiliation LBN 1	LEESBURG REGIONAL MEDICAL CENTER
	Legal business name of hospital where individual professional provides service 1
Hospital Affiliation CCN 2	100290
	Medicare CCN of hospital where individual professional provides service 2
Hospital Affiliation LBN 2	VILLAGES REGIONAL HOSPITAL, THE
	Legal business name of hospital where individual professional provides service 2
Professional Accepts Medicare Assignment	Y