Physician Compare National (NPI:1962810036)

HEALTHCARE PROVIDER: DR. TARAS VYSOTSKYY

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

Individual Professional Information
NPI	1962810036
	Unique healthcare provider (clinician) ID assigned by NPPES
PECOS UID	3274803820
	Unique individual clinician ID assigned by PECOS
Professional Enrollment ID	I20170714001341
	Unique ID for the individual professional enrollment that is the source for the data in the observation
Provider Last Name	VYSOTSKYY
	Individual professional last name
Provider First Name	TARAS
	Individual professional first name
Provider Gender	M
	The provider's gender if the provider is a person.

Medical School Information
Medical School Name	NEW YORK COLLEGE OF PODIATRIC MEDICINE
	Individual professional's medical school
Graduation Year	2014
	Individual professional's medical school graduation year
Primary Specialty	PODIATRY
	Primary medical specialty reported by the individual professional in the selected enrollment

Practice Information
Organization Legal Name	LEWIS J SIMS DPM PC
	Legal name of the Group Practice that the individual professional works with- will be blank if the address is not linked to a Group Practice
Group Practice PAC ID	6406754688
	Unique Group Practice ID assigned by PECOS to the Group Practice that the individual professional works with- will be blank if the address is not linked to a Group Practice
Number of Group Practice members	5
	Total number of individual professionals affiliated with the Group Practice based on Group Practice PAC ID
Line 1 Street Address	969 MAIN ST
	Group Practice or individual's line 1 address
Line 2 Street Address	SUITE B
	Group Practice or individual's line 2 address
City	FISHKILL
	Group Practice or individual's city
State	NY
	Group Practice or individual's state
Zip Code	125241791
	Group Practice or individual's zip code (9 digits when available)
Phone Number	8458972735
	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	330234
	Medicare CCN of hospital where individual professional provides service 1
Hospital Affiliation LBN 1	WESTCHESTER MEDICAL CENTER
	Legal business name of hospital where individual professional provides service 1
Hospital Affiliation CCN 2	330023
	Medicare CCN of hospital where individual professional provides service 2
Hospital Affiliation LBN 2	VASSAR BROTHERS MEDICAL CENTER
	Legal business name of hospital where individual professional provides service 2
Professional Accepts Medicare Assignment	Y