Physician Compare National (NPI:1790028769)

HEALTHCARE PROVIDER: AMIT DEEPAK SHAH 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	1790028769
	Unique healthcare provider (clinician) ID assigned by NPPES
PECOS UID	3779834700
	Unique individual clinician ID assigned by PECOS
Professional Enrollment ID	I20181001002374
	Unique ID for the individual professional enrollment that is the source for the data in the observation
Provider Last Name	SHAH
	Individual professional last name
Provider First Name	AMIT
	Individual professional first name
Provider Middle Name	DEEPAK
	Individual professional middle name
Provider Gender	M
	The provider's gender if the provider is a person.

Medical School Information
Medical School Name	MEDICAL COLLEGE OF GEORGIA SCHOOL OF MEDICINE
	Individual professional's medical school
Graduation Year	2013
	Individual professional's medical school graduation year
Primary Specialty	NEUROLOGY
	Primary medical specialty reported by the individual professional in the selected enrollment

Practice Information
Line 1 Street Address	6458 MERIDIAN WAY
	Group Practice or individual's line 1 address
City	SANDY SPRINGS
	Group Practice or individual's city
State	GA
	Group Practice or individual's state
Zip Code	303282895
	Group Practice or individual's zip code (9 digits when available)

Hospital(s) Affiliation Information
Hospital Affiliation CCN 1	170203
	Medicare CCN of hospital where individual professional provides service 1
Hospital Affiliation LBN 1	PREMIER SURGICAL INSTITUTE
	Legal business name of hospital where individual professional provides service 1
Hospital Affiliation CCN 2	040062
	Medicare CCN of hospital where individual professional provides service 2
Hospital Affiliation LBN 2	MERCY HOSPITAL FORT SMITH
	Legal business name of hospital where individual professional provides service 2
Hospital Affiliation CCN 3	040137
	Medicare CCN of hospital where individual professional provides service 3
Hospital Affiliation LBN 3	ST VINCENT MEDICAL CENTER/NORTH
	Legal business name of hospital where individual professional provides service 3
Hospital Affiliation CCN 4	110161
	Medicare CCN of hospital where individual professional provides service 4
Hospital Affiliation LBN 4	NORTHSIDE HOSPITAL
	Legal business name of hospital where individual professional provides service 4
Hospital Affiliation CCN 5	260001
	Medicare CCN of hospital where individual professional provides service 5
Hospital Affiliation LBN 5	MERCY HOSPITAL JOPLIN
	Legal business name of hospital where individual professional provides service 5
Professional Accepts Medicare Assignment	Y

Physician Compare National (NPI:1790028769)

HEALTHCARE PROVIDER: AMIT DEEPAK SHAH M.D.

Individual Professional Information

Medical School Information

Practice Information

Hospital(s) Affiliation Information