Physician Compare National (NPI:1922117811)

HEALTHCARE PROVIDER: MISBAHUDDIN AHMED 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	1922117811
	Unique healthcare provider (clinician) ID assigned by NPPES
PECOS UID	2466588421
	Unique individual clinician ID assigned by PECOS
Professional Enrollment ID	I20100329000903
	Unique ID for the individual professional enrollment that is the source for the data in the observation
Provider Last Name	AHMED
	Individual professional last name
Provider First Name	MISBAH
	Individual professional first name
Provider Middle Name	U
	Individual professional middle name
Provider Gender	M
	The provider's gender if the provider is a person.

Medical School Information
Medical School Name	OTHER
	Individual professional's medical school
Graduation Year	1972
	Individual professional's medical school graduation year
Primary Specialty	INTERNAL MEDICINE
	Primary medical specialty reported by the individual professional in the selected enrollment
Secondary Specialty 1	MEDICAL ONCOLOGY
	First secondary medical specialty reported by the individual professional in the selected enrollment
All Secondary Specialties	MEDICAL ONCOLOGY
	All four secondary specialties reported by the individual professional in the selected enrollment, separated by commas

Practice Information
Line 1 Street Address	555 W COURT ST
	Group Practice or individual's line 1 address
Line 2 Street Address	SUITE 200
	Group Practice or individual's line 2 address
City	KANKAKEE
	Group Practice or individual's city
State	IL
	Group Practice or individual's state
Zip Code	609013674
	Group Practice or individual's zip code (9 digits when available)

Hospital(s) Affiliation Information
Hospital Affiliation CCN 1	140155
	Medicare CCN of hospital where individual professional provides service 1
Hospital Affiliation LBN 1	PRESENCE ST MARYS HOSPITAL
	Legal business name of hospital where individual professional provides service 1
Hospital Affiliation CCN 2	140186
	Medicare CCN of hospital where individual professional provides service 2
Hospital Affiliation LBN 2	RIVERSIDE MEDICAL CENTER
	Legal business name of hospital where individual professional provides service 2
Professional Accepts Medicare Assignment	Y