Physician Compare National (NPI:1841258902)

HEALTHCARE PROVIDER: NISAL K SAMARASEKERA 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	1841258902
	Unique healthcare provider (clinician) ID assigned by NPPES
PECOS UID	8325106396
	Unique individual clinician ID assigned by PECOS
Professional Enrollment ID	I20100308000218
	Unique ID for the individual professional enrollment that is the source for the data in the observation
Provider Last Name	SAMARASEKERA
	Individual professional last name
Provider First Name	NISAL
	Individual professional first name
Provider Middle Name	K
	Individual professional middle name
Provider Gender	M
	The provider's gender if the provider is a person.

Medical School Information
Medical School Name	UNIVERSITY OF COLORADO SCHOOL OF MEDICINE, DENVER
	Individual professional's medical school
Graduation Year	1991
	Individual professional's medical school graduation year
Primary Specialty	FAMILY MEDICINE
	Primary medical specialty reported by the individual professional in the selected enrollment
Secondary Specialty 1	HOSPICE/PALLIATIVE CARE
	First secondary medical specialty reported by the individual professional in the selected enrollment
All Secondary Specialties	HOSPICE/PALLIATIVE CARE
	All four secondary specialties reported by the individual professional in the selected enrollment, separated by commas

Practice Information
Organization Legal Name	ARIZONA PALLIATIVE HOME CARE
	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	6002083508
	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	5
	Total number of individual professionals affiliated with the Group Practice based on Group Practice PAC ID
Line 1 Street Address	1510 E FLOWER ST
	Group Practice or individual's line 1 address
City	PHOENIX
	Group Practice or individual's city
State	AZ
	Group Practice or individual's state
Zip Code	850145698
	Group Practice or individual's zip code (9 digits when available)
Phone Number	6025306900
	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	030094
	Medicare CCN of hospital where individual professional provides service 1
Hospital Affiliation LBN 1	ARROWHEAD HOSPITAL
	Legal business name of hospital where individual professional provides service 1
Professional Accepts Medicare Assignment	Y