Physician Compare National (NPI:1760451298)

HEALTHCARE PROVIDER: MYSORE R NAGARAJA M.D.

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

Individual Professional Information
NPI	1760451298
	Unique healthcare provider (clinician) ID assigned by NPPES
PECOS UID	2264561547
	Unique individual clinician ID assigned by PECOS
Professional Enrollment ID	I20100525000514
	Unique ID for the individual professional enrollment that is the source for the data in the observation
Provider Last Name	NAGARAJA
	Individual professional last name
Provider First Name	MYSORE
	Individual professional first name
Provider Middle Name	R
	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	1970
	Individual professional's medical school graduation year
Primary Specialty	GASTROENTEROLOGY
	Primary medical specialty reported by the individual professional in the selected enrollment

Practice Information
Line 1 Street Address	17075 DEVONSHIRE ST
	Group Practice or individual's line 1 address
Line 2 Street Address	SUITE 200
	Group Practice or individual's line 2 address
City	NORTHRIDGE
	Group Practice or individual's city
State	CA
	Group Practice or individual's state
Zip Code	913255407
	Group Practice or individual's zip code (9 digits when available)

Hospital(s) Affiliation Information
Hospital Affiliation CCN 1	050278
	Medicare CCN of hospital where individual professional provides service 1
Hospital Affiliation LBN 1	PROVIDENCE HOLY CROSS MEDICAL CENTER
	Legal business name of hospital where individual professional provides service 1
Hospital Affiliation CCN 2	050231
	Medicare CCN of hospital where individual professional provides service 2
Hospital Affiliation LBN 2	POMONA VALLEY HOSPITAL MEDICAL CENTER
	Legal business name of hospital where individual professional provides service 2
Professional Accepts Medicare Assignment	Y