Physician Compare National (NPI:1649281346)

HEALTHCARE PROVIDER: JOHN BRADFORD FASANO M.D.

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

Individual Professional Information
NPI	1649281346
	Unique healthcare provider (clinician) ID assigned by NPPES
PECOS UID	9931392750
	Unique individual clinician ID assigned by PECOS
Professional Enrollment ID	I20101025000541
	Unique ID for the individual professional enrollment that is the source for the data in the observation
Provider Last Name	FASANO
	Individual professional last name
Provider First Name	JOHN
	Individual professional first name
Provider Middle Name	BRADFORD
	Individual professional middle name
Provider Gender	M
	The provider's gender if the provider is a person.

Medical School Information
Medical School Name	GEISEL SCHOOL OF MEDICINE AT DARTMOUTH
	Individual professional's medical school
Graduation Year	1985
	Individual professional's medical school graduation year
Primary Specialty	PLASTIC AND RECONSTRUCTIVE SURGERY
	Primary medical specialty reported by the individual professional in the selected enrollment

Practice Information
Line 1 Street Address	509 SE RIVERSIDE DR
	Group Practice or individual's line 1 address
Line 2 Street Address	SUITE 206
	Group Practice or individual's line 2 address
City	STUART
	Group Practice or individual's city
State	FL
	Group Practice or individual's state
Zip Code	349942579
	Group Practice or individual's zip code (9 digits when available)
Phone Number	7722219111
	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	100044
	Medicare CCN of hospital where individual professional provides service 1
Hospital Affiliation LBN 1	MARTIN MEDICAL CENTER
	Legal business name of hospital where individual professional provides service 1
Professional Accepts Medicare Assignment	Y