Physician Compare National (NPI:1811903222)

HEALTHCARE PROVIDER: MANISH KUMAR BANSAL 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	1811903222
	Unique healthcare provider (clinician) ID assigned by NPPES
PECOS UID	2668570078
	Unique individual clinician ID assigned by PECOS
Professional Enrollment ID	I20200330000617
	Unique ID for the individual professional enrollment that is the source for the data in the observation
Provider Last Name	BANSAL
	Individual professional last name
Provider First Name	MANISH
	Individual professional first name
Provider Gender	M
	The provider's gender if the provider is a person.
Provider Credential Text	MD
	The abbreviations for professional degrees or credentials used or held by the provider, if the provider is an individual. Examples are MD, DDS, CSW, CNA, AA, NP, RNA, or PSY. These credential designations will not be verified by NPS.

Medical School Information
Medical School Name	GEORGE WASHINGTON UNIVERSITY SCHOOL OF MEDICINE
	Individual professional's medical school
Graduation Year	1999
	Individual professional's medical school graduation year
Primary Specialty	CARDIOVASCULAR DISEASE (CARDIOLOGY)
	Primary medical specialty reported by the individual professional in the selected enrollment

Practice Information
Organization Legal Name	COFFEE REGIONAL MEDICAL CENTER 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	4587656012
	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	18
	Total number of individual professionals affiliated with the Group Practice based on Group Practice PAC ID
Line 1 Street Address	1101 OCILLA RD
	Group Practice or individual's line 1 address
City	DOUGLAS
	Group Practice or individual's city
State	GA
	Group Practice or individual's state
Zip Code	315332207
	Group Practice or individual's zip code (9 digits when available)
Phone Number	9123841900
	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	100226
	Medicare CCN of hospital where individual professional provides service 1
Hospital Affiliation LBN 1	ORANGE PARK MEDICAL CENTER
	Legal business name of hospital where individual professional provides service 1
Hospital Affiliation CCN 2	110089
	Medicare CCN of hospital where individual professional provides service 2
Hospital Affiliation LBN 2	COFFEE REGIONAL MEDICAL CENTER
	Legal business name of hospital where individual professional provides service 2
Hospital Affiliation CCN 3	100040
	Medicare CCN of hospital where individual professional provides service 3
Hospital Affiliation LBN 3	ST VINCENT'S MEDICAL CENTER RIVERSIDE
	Legal business name of hospital where individual professional provides service 3
Hospital Affiliation CCN 4	480001
	Medicare CCN of hospital where individual professional provides service 4
Hospital Affiliation LBN 4	ROY LESTER SCHNEIDER HOSPITAL,THE
	Legal business name of hospital where individual professional provides service 4
Professional Accepts Medicare Assignment	Y