Physician Compare National (NPI:1861442055)

HEALTHCARE PROVIDER: MORTEZA S MOUSAVI 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	1861442055
	Unique healthcare provider (clinician) ID assigned by NPPES
PECOS UID	5597890632
	Unique individual clinician ID assigned by PECOS
Professional Enrollment ID	I20100315000932
	Unique ID for the individual professional enrollment that is the source for the data in the observation
Provider Last Name	MOUSAVI
	Individual professional last name
Provider First Name	MORTEZA
	Individual professional first name
Provider Middle Name	S
	Individual professional middle name
Provider Gender	M
	The provider's gender if the provider is a person.

Medical School Information
Medical School Name	CLVLND CLINIC LERNER COLLEGE OF MED OF CASE WSTN RSV UNIVERSITY
	Individual professional's medical school
Primary Specialty	CARDIOVASCULAR DISEASE (CARDIOLOGY)
	Primary medical specialty reported by the individual professional in the selected enrollment

Practice Information
Line 1 Street Address	2296 OPITZ BLVD
	Group Practice or individual's line 1 address
Line 2 Street Address	SUITE 340
	Group Practice or individual's line 2 address
City	WOODBRIDGE
	Group Practice or individual's city
State	VA
	Group Practice or individual's state
Zip Code	221913346
	Group Practice or individual's zip code (9 digits when available)

Hospital(s) Affiliation Information
Hospital Affiliation CCN 1	490113
	Medicare CCN of hospital where individual professional provides service 1
Hospital Affiliation LBN 1	SENTARA NORTHERN VIRGINIA MEDICAL CENTER
	Legal business name of hospital where individual professional provides service 1
Professional Accepts Medicare Assignment	Y