Physician Compare National (NPI:1881890432)

HEALTHCARE PROVIDER: REUBEN I THAKER MD MPH

Physician Compare National contains general information about individual eligible professionals (EPs) such as demographic information and Medicare quality program participation.

Individual Professional Information
NPI	1881890432
	Unique healthcare provider (clinician) ID assigned by NPPES
PECOS UID	1658438478
	Unique individual clinician ID assigned by PECOS
Professional Enrollment ID	I20190425000157
	Unique ID for the individual professional enrollment that is the source for the data in the observation
Provider Last Name	THAKER
	Individual professional last name
Provider First Name	REUBEN
	Individual professional first name
Provider Gender	M
	The provider's gender if the provider is a person.

Medical School Information
Medical School Name	UNIVERSITY OF TENNESSEE, HSC, COLLEGE OF MEDICINE
	Individual professional's medical school
Graduation Year	1996
	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	PAIN MANAGEMENT
	First secondary medical specialty reported by the individual professional in the selected enrollment
All Secondary Specialties	PAIN MANAGEMENT
	All four secondary specialties reported by the individual professional in the selected enrollment, separated by commas

Practice Information
Line 1 Street Address	9420 W SAHARA AVE
	Group Practice or individual's line 1 address
Line 2 Street Address	SUITE 105
	Group Practice or individual's line 2 address
City	LAS VEGAS
	Group Practice or individual's city
State	NV
	Group Practice or individual's state
Zip Code	891178800
	Group Practice or individual's zip code (9 digits when available)

Hospital(s) Affiliation Information
Hospital Affiliation CCN 1	261332
	Medicare CCN of hospital where individual professional provides service 1
Hospital Affiliation LBN 1	CARROLL COUNTY MEMORIAL HOSPITAL
	Legal business name of hospital where individual professional provides service 1
Professional Accepts Medicare Assignment	Y