Physician Compare National (NPI:1639255847)

HEALTHCARE PROVIDER: MICHAEL SALVATORE LAROSA 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	1639255847
	Unique healthcare provider (clinician) ID assigned by NPPES
PECOS UID	1759415953
	Unique individual clinician ID assigned by PECOS
Professional Enrollment ID	I20100810000343
	Unique ID for the individual professional enrollment that is the source for the data in the observation
Provider Last Name	LAROSA
	Individual professional last name
Provider First Name	MICHAEL
	Individual professional first name
Provider Middle Name	S
	Individual professional middle name
Provider Gender	M
	The provider's gender if the provider is a person.

Medical School Information
Medical School Name	INDIANA UNIVERSITY SCHOOL OF MEDICINE
	Individual professional's medical school
Graduation Year	1988
	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
Line 1 Street Address	6920 PARKDALE PL
	Group Practice or individual's line 1 address
Line 2 Street Address	SUITE 101
	Group Practice or individual's line 2 address
City	INDIANAPOLIS
	Group Practice or individual's city
State	IN
	Group Practice or individual's state
Zip Code	462545604
	Group Practice or individual's zip code (9 digits when available)
Phone Number	3173904524
	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	150056
	Medicare CCN of hospital where individual professional provides service 1
Hospital Affiliation LBN 1	INDIANA UNIVERSITY HEALTH METHODIST HOSPITAL (INDIANAPOLIS)
	Legal business name of hospital where individual professional provides service 1
Hospital Affiliation CCN 2	150158
	Medicare CCN of hospital where individual professional provides service 2
Hospital Affiliation LBN 2	IU HEALTH WEST HOSPITAL
	Legal business name of hospital where individual professional provides service 2
Hospital Affiliation CCN 3	150005
	Medicare CCN of hospital where individual professional provides service 3
Hospital Affiliation LBN 3	HENDRICKS REGIONAL HEALTH
	Legal business name of hospital where individual professional provides service 3
Hospital Affiliation CCN 4	150057
	Medicare CCN of hospital where individual professional provides service 4
Hospital Affiliation LBN 4	FRANCISCAN HEALTH MOORESVILLE
	Legal business name of hospital where individual professional provides service 4
Hospital Affiliation CCN 5	150162
	Medicare CCN of hospital where individual professional provides service 5
Hospital Affiliation LBN 5	FRANCISCAN HEALTH INDIANAPOLIS
	Legal business name of hospital where individual professional provides service 5
Professional Accepts Medicare Assignment	Y

Physician Compare National (NPI:1639255847)

HEALTHCARE PROVIDER: MICHAEL SALVATORE LAROSA MD

Individual Professional Information

Medical School Information

Practice Information

Hospital(s) Affiliation Information