Physician Compare National (NPI:1730121237)

HEALTHCARE PROVIDER: DORA V SAVANI-BLACKHAM 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	1730121237
	Unique healthcare provider (clinician) ID assigned by NPPES
PECOS UID	1557444023
	Unique individual clinician ID assigned by PECOS
Professional Enrollment ID	I20120223000849
	Unique ID for the individual professional enrollment that is the source for the data in the observation
Provider Last Name	SAVANI
	Individual professional last name
Provider First Name	DORA
	Individual professional first 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	1982
	Individual professional's medical school graduation year
Primary Specialty	INFECTIOUS DISEASE
	Primary medical specialty reported by the individual professional in the selected enrollment

Practice Information
Organization Legal Name	INFECTIOUS DISEASE CONSULTANTS INC
	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	0749243806
	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	3
	Total number of individual professionals affiliated with the Group Practice based on Group Practice PAC ID
Line 1 Street Address	20 MEDICAL VILLAGE DR
	Group Practice or individual's line 1 address
Line 2 Street Address	SUITE 355
	Group Practice or individual's line 2 address
City	EDGEWOOD
	Group Practice or individual's city
State	KY
	Group Practice or individual's state
Zip Code	410175414
	Group Practice or individual's zip code (9 digits when available)
Phone Number	8593441512
	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	180001
	Medicare CCN of hospital where individual professional provides service 1
Hospital Affiliation LBN 1	ST ELIZABETH FT THOMAS
	Legal business name of hospital where individual professional provides service 1
Hospital Affiliation CCN 2	180035
	Medicare CCN of hospital where individual professional provides service 2
Hospital Affiliation LBN 2	ST ELIZABETH EDGEWOOD
	Legal business name of hospital where individual professional provides service 2
Hospital Affiliation CCN 3	180045
	Medicare CCN of hospital where individual professional provides service 3
Hospital Affiliation LBN 3	ST ELIZABETH FLORENCE
	Legal business name of hospital where individual professional provides service 3
Professional Accepts Medicare Assignment	Y