Physician Compare National (NPI:1760529515)

HEALTHCARE PROVIDER: MOHAN SENGODAN 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	1760529515
	Unique healthcare provider (clinician) ID assigned by NPPES
PECOS UID	5890863161
	Unique individual clinician ID assigned by PECOS
Professional Enrollment ID	I20081014000528
	Unique ID for the individual professional enrollment that is the source for the data in the observation
Provider Last Name	SENGODAN
	Individual professional last name
Provider First Name	MOHAN
	Individual professional first 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	2001
	Individual professional's medical school graduation year
Primary Specialty	HOSPITALIST
	Primary medical specialty reported by the individual professional in the selected enrollment
Secondary Specialty 1	INTERNAL MEDICINE
	First secondary medical specialty reported by the individual professional in the selected enrollment
All Secondary Specialties	INTERNAL MEDICINE
	All four secondary specialties reported by the individual professional in the selected enrollment, separated by commas

Practice Information
Organization Legal Name	DIVINE SAVIOR HEALTHCARE 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	5799684007
	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	73
	Total number of individual professionals affiliated with the Group Practice based on Group Practice PAC ID
Line 1 Street Address	2817 NEW PINERY RD
	Group Practice or individual's line 1 address
City	PORTAGE
	Group Practice or individual's city
State	WI
	Group Practice or individual's state
Zip Code	539019240
	Group Practice or individual's zip code (9 digits when available)
Phone Number	6087424131
	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	450672
	Medicare CCN of hospital where individual professional provides service 1
Hospital Affiliation LBN 1	MEDICAL CITY FORT WORTH
	Legal business name of hospital where individual professional provides service 1
Hospital Affiliation CCN 2	450087
	Medicare CCN of hospital where individual professional provides service 2
Hospital Affiliation LBN 2	MEDICAL CITY NORTH HILLS
	Legal business name of hospital where individual professional provides service 2
Hospital Affiliation CCN 3	520041
	Medicare CCN of hospital where individual professional provides service 3
Hospital Affiliation LBN 3	DIVINE SAVIOR HEALTHCARE
	Legal business name of hospital where individual professional provides service 3
Hospital Affiliation CCN 4	520070
	Medicare CCN of hospital where individual professional provides service 4
Hospital Affiliation LBN 4	MAYO CLINIC HEALTH SYSTEM EAU CLAIRE HOSPITAL
	Legal business name of hospital where individual professional provides service 4
Hospital Affiliation CCN 5	521340
	Medicare CCN of hospital where individual professional provides service 5
Hospital Affiliation LBN 5	MAYO CLINIC HEALTH SYSTEM-RED CEDAR INC
	Legal business name of hospital where individual professional provides service 5
Professional Accepts Medicare Assignment	Y

Physician Compare National (NPI:1760529515)

HEALTHCARE PROVIDER: MOHAN SENGODAN MD

Individual Professional Information

Medical School Information

Practice Information

Hospital(s) Affiliation Information