Physician Compare National (NPI:1811171705)

HEALTHCARE PROVIDER: SHYAM SUNDER POLUDASU 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	1811171705
	Unique healthcare provider (clinician) ID assigned by NPPES
PECOS UID	3072648518
	Unique individual clinician ID assigned by PECOS
Professional Enrollment ID	I20120215000723
	Unique ID for the individual professional enrollment that is the source for the data in the observation
Provider Last Name	POLUDASU
	Individual professional last name
Provider First Name	SHYAM
	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	2000
	Individual professional's medical school graduation year
Primary Specialty	INTERVENTIONAL CARDIOLOGY
	Primary medical specialty reported by the individual professional in the selected enrollment
Secondary Specialty 1	CARDIOVASCULAR DISEASE (CARDIOLOGY)
	First secondary medical specialty reported by the individual professional in the selected enrollment
All Secondary Specialties	CARDIOVASCULAR DISEASE (CARDIOLOGY)
	All four secondary specialties reported by the individual professional in the selected enrollment, separated by commas

Practice Information
Organization Legal Name	STILLWATER MEDICAL CENTER AUTHORITY
	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	2365353794
	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	134
	Total number of individual professionals affiliated with the Group Practice based on Group Practice PAC ID
Line 1 Street Address	1301 W 6TH AVE
	Group Practice or individual's line 1 address
Line 2 Street Address	SUITE 207
	Group Practice or individual's line 2 address
City	STILLWATER
	Group Practice or individual's city
State	OK
	Group Practice or individual's state
Zip Code	740744381
	Group Practice or individual's zip code (9 digits when available)
Phone Number	4055333010
	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	370049
	Medicare CCN of hospital where individual professional provides service 1
Hospital Affiliation LBN 1	STILLWATER MEDICAL CENTER
	Legal business name of hospital where individual professional provides service 1
Hospital Affiliation CCN 2	370001
	Medicare CCN of hospital where individual professional provides service 2
Hospital Affiliation LBN 2	HILLCREST MEDICAL CENTER
	Legal business name of hospital where individual professional provides service 2
Hospital Affiliation CCN 3	370139
	Medicare CCN of hospital where individual professional provides service 3
Hospital Affiliation LBN 3	PERRY MEMORIAL HOSPITAL AUTHORITY
	Legal business name of hospital where individual professional provides service 3
Hospital Affiliation CCN 4	370215
	Medicare CCN of hospital where individual professional provides service 4
Hospital Affiliation LBN 4	OKLAHOMA HEART HOSPITAL, LLC
	Legal business name of hospital where individual professional provides service 4
Professional Accepts Medicare Assignment	Y