Physician Compare National (NPI:1942303367)

HEALTHCARE PROVIDER: MOHAMMAD ALI BAKHTAVAR 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	1942303367
	Unique healthcare provider (clinician) ID assigned by NPPES
PECOS UID	3274675913
	Unique individual clinician ID assigned by PECOS
Professional Enrollment ID	I20100119000644
	Unique ID for the individual professional enrollment that is the source for the data in the observation
Provider Last Name	BAKHTAVAR
	Individual professional last name
Provider First Name	MOHAMMAD
	Individual professional first name
Provider Middle Name	A
	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	1966
	Individual professional's medical school graduation year
Primary Specialty	OBSTETRICS/GYNECOLOGY
	Primary medical specialty reported by the individual professional in the selected enrollment

Practice Information
Line 1 Street Address	205 N 1ST ST
	Group Practice or individual's line 1 address
Line 2 Street Address	SUITE D
	Group Practice or individual's line 2 address
City	BLYTHE
	Group Practice or individual's city
State	CA
	Group Practice or individual's state
Zip Code	922251777
	Group Practice or individual's zip code (9 digits when available)
Phone Number	7609226667
	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	050423
	Medicare CCN of hospital where individual professional provides service 1
Hospital Affiliation LBN 1	PALO VERDE HOSPITAL
	Legal business name of hospital where individual professional provides service 1
Hospital Affiliation CCN 2	050243
	Medicare CCN of hospital where individual professional provides service 2
Hospital Affiliation LBN 2	DESERT REGIONAL MEDICAL CENTER
	Legal business name of hospital where individual professional provides service 2
Professional Accepts Medicare Assignment	Y