Physician Compare National (NPI:1699115535)

HEALTHCARE PROVIDER: WAFA ELHASSAN 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	1699115535
	Unique healthcare provider (clinician) ID assigned by NPPES
PECOS UID	8022377878
	Unique individual clinician ID assigned by PECOS
Professional Enrollment ID	I20180124000733
	Unique ID for the individual professional enrollment that is the source for the data in the observation
Provider Last Name	ELHASSAN
	Individual professional last name
Provider First Name	WAFA
	Individual professional first name
Provider Middle Name	A
	Individual professional middle name
Provider Gender	F
	The provider's gender if the provider is a person.

Medical School Information
Medical School Name	OTHER
	Individual professional's medical school
Graduation Year	2004
	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	1905 S HAGGERTY RD
	Group Practice or individual's line 1 address
City	CANTON
	Group Practice or individual's city
State	MI
	Group Practice or individual's state
Zip Code	481882025
	Group Practice or individual's zip code (9 digits when available)

Hospital(s) Affiliation Information
Hospital Affiliation CCN 1	230020
	Medicare CCN of hospital where individual professional provides service 1
Hospital Affiliation LBN 1	BEAUMONT HOSPITAL - DEARBORN
	Legal business name of hospital where individual professional provides service 1
Hospital Affiliation CCN 2	230270
	Medicare CCN of hospital where individual professional provides service 2
Hospital Affiliation LBN 2	BEAUMONT HOSPITAL - TAYLOR
	Legal business name of hospital where individual professional provides service 2
Hospital Affiliation CCN 3	230142
	Medicare CCN of hospital where individual professional provides service 3
Hospital Affiliation LBN 3	BEAUMONT HOSPITAL - WAYNE
	Legal business name of hospital where individual professional provides service 3
Professional Accepts Medicare Assignment	Y