Physician Compare National (NPI:1659358836)

HEALTHCARE PROVIDER: RAJEEV K GUPTA 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	1659358836
	Unique healthcare provider (clinician) ID assigned by NPPES
PECOS UID	8921180365
	Unique individual clinician ID assigned by PECOS
Professional Enrollment ID	I20080603000885
	Unique ID for the individual professional enrollment that is the source for the data in the observation
Provider Last Name	GUPTA
	Individual professional last name
Provider First Name	RAJEEV
	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	1983
	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	905 VICTORY HWY
	Group Practice or individual's line 1 address
City	SLATERSVILLE
	Group Practice or individual's city
State	RI
	Group Practice or individual's state
Zip Code	02876
	Group Practice or individual's zip code (9 digits when available)

Hospital(s) Affiliation Information
Hospital Affiliation CCN 1	410012
	Medicare CCN of hospital where individual professional provides service 1
Hospital Affiliation LBN 1	THE MIRIAM HOSPITAL
	Legal business name of hospital where individual professional provides service 1
Hospital Affiliation CCN 2	410011
	Medicare CCN of hospital where individual professional provides service 2
Hospital Affiliation LBN 2	LANDMARK MEDICAL CENTER
	Legal business name of hospital where individual professional provides service 2
Hospital Affiliation CCN 3	410005
	Medicare CCN of hospital where individual professional provides service 3
Hospital Affiliation LBN 3	OUR LADY OF FATIMA HOSPITAL
	Legal business name of hospital where individual professional provides service 3
Professional Accepts Medicare Assignment	Y