Physician Compare National (NPI:1972610491)

HEALTHCARE PROVIDER: MANOUCHER RAVAEE 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	1972610491
	Unique healthcare provider (clinician) ID assigned by NPPES
PECOS UID	0446446041
	Unique individual clinician ID assigned by PECOS
Professional Enrollment ID	I20101122000802
	Unique ID for the individual professional enrollment that is the source for the data in the observation
Provider Last Name	RAVAEE
	Individual professional last name
Provider First Name	MANOUCHER
	Individual professional first 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	1960
	Individual professional's medical school graduation year
Primary Specialty	INTERNAL MEDICINE
	Primary medical specialty reported by the individual professional in the selected enrollment

Practice Information
Line 1 Street Address	733 LOGAN AVE
	Group Practice or individual's line 1 address
Line 2 Street Address	SUITE 3
	Group Practice or individual's line 2 address
City	DANVILLE
	Group Practice or individual's city
State	IL
	Group Practice or individual's state
Zip Code	618324395
	Group Practice or individual's zip code (9 digits when available)
Phone Number	2174423268
	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	140093
	Medicare CCN of hospital where individual professional provides service 1
Hospital Affiliation LBN 1	PRESENCE UNITED SAMARITANS MEDICAL CENTER
	Legal business name of hospital where individual professional provides service 1
Hospital Affiliation CCN 2	140113
	Medicare CCN of hospital where individual professional provides service 2
Hospital Affiliation LBN 2	PRESENCE COVENANT MEDICAL CENTER- URBANA
	Legal business name of hospital where individual professional provides service 2
Professional Accepts Medicare Assignment	Y