Physician Compare National (NPI:1639145659)

HEALTHCARE PROVIDER: MIKHAIL M. SHPAK D.O.

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

Individual Professional Information
NPI	1639145659
	Unique healthcare provider (clinician) ID assigned by NPPES
PECOS UID	3274503081
	Unique individual clinician ID assigned by PECOS
Professional Enrollment ID	I20040729000175
	Unique ID for the individual professional enrollment that is the source for the data in the observation
Provider Last Name	SHPAK
	Individual professional last name
Provider First Name	MIKHAIL
	Individual professional first name
Provider Middle Name	M
	Individual professional middle name
Provider Gender	M
	The provider's gender if the provider is a person.
Provider Credential Text	DO
	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	NEW YORK COLLEGE OF OSTEO MEDICINE OF NEW YORK INSTITUTE OF TECHNOLOGY
	Individual professional's medical school
Graduation Year	1999
	Individual professional's medical school graduation year
Primary Specialty	FAMILY MEDICINE
	Primary medical specialty reported by the individual professional in the selected enrollment

Practice Information
Organization Legal Name	SEAGATE FAMILY MEDICINE ASSOCIATES, 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	2668471624
	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	4
	Total number of individual professionals affiliated with the Group Practice based on Group Practice PAC ID
Line 1 Street Address	2064 CROPSEY AVE
	Group Practice or individual's line 1 address
Line 2 Street Address	SUITE 1G
	Group Practice or individual's line 2 address
City	BROOKLYN
	Group Practice or individual's city
State	NY
	Group Practice or individual's state
Zip Code	112146208
	Group Practice or individual's zip code (9 digits when available)
Phone Number	7189758765
	Phone number is listed only when there is a single phone number available for the practice location address

Hospital(s) Affiliation Information
Hospital Affiliation CCN 1	330019
	Medicare CCN of hospital where individual professional provides service 1
Hospital Affiliation LBN 1	NEW YORK COMMUNITY HOSPITAL OF BROOKLYN, INC.
	Legal business name of hospital where individual professional provides service 1
Hospital Affiliation CCN 2	330194
	Medicare CCN of hospital where individual professional provides service 2
Hospital Affiliation LBN 2	MAIMONIDES MEDICAL CENTER
	Legal business name of hospital where individual professional provides service 2
Hospital Affiliation CCN 3	330236
	Medicare CCN of hospital where individual professional provides service 3
Hospital Affiliation LBN 3	NEW YORK-PRESBYTERIAN/BROOKLYN METHODIST HOSPITAL
	Legal business name of hospital where individual professional provides service 3
Professional Accepts Medicare Assignment	M