Physician Compare National (NPI:1720213093)

HEALTHCARE PROVIDER: EMMANUEL GAGE

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

Individual Professional Information
NPI	1720213093
	Unique healthcare provider (clinician) ID assigned by NPPES
PECOS UID	0749405702
	Unique individual clinician ID assigned by PECOS
Professional Enrollment ID	I20200306001968
	Unique ID for the individual professional enrollment that is the source for the data in the observation
Provider Last Name	GAGE
	Individual professional last name
Provider First Name	EMMANUEL
	Individual professional first name
Provider Middle Name	GEORGE
	Individual professional middle 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	2009
	Individual professional's medical school graduation year
Primary Specialty	PHYSICAL MEDICINE AND REHABILITATION
	Primary medical specialty reported by the individual professional in the selected enrollment

Practice Information
Line 1 Street Address	1507 ALICE ST
	Group Practice or individual's line 1 address
City	WAYCROSS
	Group Practice or individual's city
State	GA
	Group Practice or individual's state
Zip Code	315014530
	Group Practice or individual's zip code (9 digits when available)

Hospital(s) Affiliation Information
Hospital Affiliation CCN 1	110003
	Medicare CCN of hospital where individual professional provides service 1
Hospital Affiliation LBN 1	MAYO CLINIC HEALTH SYSTEM IN WAYCROSS
	Legal business name of hospital where individual professional provides service 1
Hospital Affiliation CCN 2	110146
	Medicare CCN of hospital where individual professional provides service 2
Hospital Affiliation LBN 2	SOUTHEAST GEORGIA HEALTH SYSTEM -- CAMDEN CAMPUS
	Legal business name of hospital where individual professional provides service 2
Hospital Affiliation CCN 3	110089
	Medicare CCN of hospital where individual professional provides service 3
Hospital Affiliation LBN 3	COFFEE REGIONAL MEDICAL CENTER
	Legal business name of hospital where individual professional provides service 3
Hospital Affiliation CCN 4	110025
	Medicare CCN of hospital where individual professional provides service 4
Hospital Affiliation LBN 4	SOUTHEAST GEORGIA HEALTH SYSTEM- BRUNSWICK CAMPUS
	Legal business name of hospital where individual professional provides service 4
Hospital Affiliation CCN 5	110124
	Medicare CCN of hospital where individual professional provides service 5
Hospital Affiliation LBN 5	WAYNE MEMORIAL HOSPITAL
	Legal business name of hospital where individual professional provides service 5
Professional Accepts Medicare Assignment	M

Physician Compare National (NPI:1720213093)

HEALTHCARE PROVIDER: EMMANUEL GAGE

Individual Professional Information

Medical School Information

Practice Information

Hospital(s) Affiliation Information