Physician Compare National (NPI:1811195894)

HEALTHCARE PROVIDER: KALPANA GORTHI 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	1811195894
	Unique healthcare provider (clinician) ID assigned by NPPES
PECOS UID	4587853189
	Unique individual clinician ID assigned by PECOS
Professional Enrollment ID	I20180613002061
	Unique ID for the individual professional enrollment that is the source for the data in the observation
Provider Last Name	GORTHI
	Individual professional last name
Provider First Name	KALPANA
	Individual professional first name
Provider Gender	F
	The provider's gender if the provider is a person.

Medical School Information
Medical School Name	OTHER
	Individual professional's medical school
Graduation Year	2002
	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	6450 N WICKHAM RD
	Group Practice or individual's line 1 address
Line 2 Street Address	SUITE 106
	Group Practice or individual's line 2 address
City	MELBOURNE
	Group Practice or individual's city
State	FL
	Group Practice or individual's state
Zip Code	329402036
	Group Practice or individual's zip code (9 digits when available)

Hospital(s) Affiliation Information
Hospital Affiliation CCN 1	100092
	Medicare CCN of hospital where individual professional provides service 1
Hospital Affiliation LBN 1	WUESTHOFF MEDICAL CENTER ROCKLEDGE
	Legal business name of hospital where individual professional provides service 1
Hospital Affiliation CCN 2	100291
	Medicare CCN of hospital where individual professional provides service 2
Hospital Affiliation LBN 2	STEWARD MELBOURNE HOSPITAL
	Legal business name of hospital where individual professional provides service 2
Hospital Affiliation CCN 3	100315
	Medicare CCN of hospital where individual professional provides service 3
Hospital Affiliation LBN 3	VIERA HOSPITAL
	Legal business name of hospital where individual professional provides service 3
Professional Accepts Medicare Assignment	Y