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Physician Compare National (NPI:1649567926)

HEALTHCARE PROVIDER: CHAROEN MANKONGPAISARNRUNG 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 1649567926
Unique healthcare provider (clinician) ID assigned by NPPES
PECOS UID 8527330836
Unique individual clinician ID assigned by PECOS
Professional Enrollment ID I20170822001870
Unique ID for the individual professional enrollment that is the source for the data in the observation
Provider Last Name MANKONGPAISARNRUNG
Individual professional last name
Provider First Name CHAROEN
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 2007
Individual professional's medical school graduation year
Primary Specialty GASTROENTEROLOGY
Primary medical specialty reported by the individual professional in the selected enrollment
Secondary Specialty 1 INTERNAL MEDICINE
First secondary medical specialty reported by the individual professional in the selected enrollment
All Secondary Specialties INTERNAL MEDICINE
All four secondary specialties reported by the individual professional in the selected enrollment, separated by commas

Practice Information

Organization Legal Name SANFORD MEDICAL CENTER
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 8325950215
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 537
Total number of individual professionals affiliated with the Group Practice based on Group Practice PAC ID
Line 1 Street Address 1600 W 22ND ST
Group Practice or individual's line 1 address
City SIOUX FALLS
Group Practice or individual's city
State SD
Group Practice or individual's state
Zip Code 571051521
Group Practice or individual's zip code (9 digits when available)
Phone Number 6053289515
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 430027
Medicare CCN of hospital where individual professional provides service 1
Hospital Affiliation LBN 1 SANFORD USD MEDICAL CENTER
Legal business name of hospital where individual professional provides service 1
Hospital Affiliation CCN 2 431329
Medicare CCN of hospital where individual professional provides service 2
Hospital Affiliation LBN 2 SANFORD CHAMBERLAIN MEDICAL CENTER
Legal business name of hospital where individual professional provides service 2
Hospital Affiliation CCN 3 240022
Medicare CCN of hospital where individual professional provides service 3
Hospital Affiliation LBN 3 SANFORD MEDICAL CENTER WORTHINGTON
Legal business name of hospital where individual professional provides service 3
Hospital Affiliation CCN 4 161381
Medicare CCN of hospital where individual professional provides service 4
Hospital Affiliation LBN 4 SANFORD SHELDON MEDICAL CENTER
Legal business name of hospital where individual professional provides service 4
Hospital Affiliation CCN 5 241371
Medicare CCN of hospital where individual professional provides service 5
Hospital Affiliation LBN 5 SANFORD LUVERNE MEDICAL CENTER
Legal business name of hospital where individual professional provides service 5
Professional Accepts Medicare Assignment Y

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