Physician Compare National (NPI:1740359629)

HEALTHCARE PROVIDER: SHASHI MADAN 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	1740359629
	Unique healthcare provider (clinician) ID assigned by NPPES
PECOS UID	1052442746
	Unique individual clinician ID assigned by PECOS
Professional Enrollment ID	I20100624000219
	Unique ID for the individual professional enrollment that is the source for the data in the observation
Provider Last Name	MADAN
	Individual professional last name
Provider First Name	SHASHI
	Individual professional first name
Provider Middle Name	S
	Individual professional middle name
Provider Gender	F
	The provider's gender if the provider is a person.

Medical School Information
Medical School Name	GEORGETOWN UNIVERSITY SCHOOL OF MEDICINE
	Individual professional's medical school
Graduation Year	1992
	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	135 N OAK ST
	Group Practice or individual's line 1 address
City	JACKSON
	Group Practice or individual's city
State	GA
	Group Practice or individual's state
Zip Code	302331942
	Group Practice or individual's zip code (9 digits when available)

Hospital(s) Affiliation Information
Hospital Affiliation CCN 1	110031
	Medicare CCN of hospital where individual professional provides service 1
Hospital Affiliation LBN 1	WELLSTAR SPALDING REGIONAL HOSPITAL
	Legal business name of hospital where individual professional provides service 1
Hospital Affiliation CCN 2	111303
	Medicare CCN of hospital where individual professional provides service 2
Hospital Affiliation LBN 2	JASPER MEMORIAL HOSPITAL
	Legal business name of hospital where individual professional provides service 2
Professional Accepts Medicare Assignment	Y