Physician Compare National (NPI:1952392441)

HEALTHCARE PROVIDER:

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

Individual Professional Information
NPI	1952392441
	Unique healthcare provider (clinician) ID assigned by NPPES
PECOS UID	6709074750
	Unique individual clinician ID assigned by PECOS
Professional Enrollment ID	I20101217000605
	Unique ID for the individual professional enrollment that is the source for the data in the observation
Provider Last Name	NAZEERI
	Individual professional last name
Provider First Name	MUSADDIQ
	Individual professional first name
Provider Middle Name	N
	Individual professional middle name
Provider Gender	M
	The provider's gender if the provider is a person.

Medical School Information
Medical School Name	WAYNE STATE UNIVERSITY SCHOOL OF MEDICINE
	Individual professional's medical school
Graduation Year	1995
	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	ALLERGY/IMMUNOLOGY
	First secondary medical specialty reported by the individual professional in the selected enrollment
Secondary Specialty 2	DERMATOLOGY
	Second secondary medical specialty reported by the individual professional in the selected enrollment
Secondary Specialty 3	GERIATRIC MEDICINE
	Third secondary medical specialty reported by the individual professional in the selected enrollment
Secondary Specialty 4	INTERNAL MEDICINE
	Fourth secondary medical specialty reported by the individual professional in the selected enrollment
All Secondary Specialties	ALLERGY/IMMUNOLOGY, DERMATOLOGY, GERIATRIC MEDICINE, INTERNAL MEDICINE
	All four secondary specialties reported by the individual professional in the selected enrollment, separated by commas

Practice Information
Line 1 Street Address	1023 POPLAR ST
	Group Practice or individual's line 1 address
City	LEBANON
	Group Practice or individual's city
State	PA
	Group Practice or individual's state
Zip Code	170426636
	Group Practice or individual's zip code (9 digits when available)

Hospital(s) Affiliation Information
Hospital Affiliation CCN 1	390066
	Medicare CCN of hospital where individual professional provides service 1
Hospital Affiliation LBN 1	GOOD SAMARITAN HOSPITAL
	Legal business name of hospital where individual professional provides service 1
Professional Accepts Medicare Assignment	Y