Physician Compare National (NPI:1982730636)

HEALTHCARE PROVIDER: RUSSELL RAYMOND SUDA SR. 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	1982730636
	Unique healthcare provider (clinician) ID assigned by NPPES
PECOS UID	0749174050
	Unique individual clinician ID assigned by PECOS
Professional Enrollment ID	I20040209000932
	Unique ID for the individual professional enrollment that is the source for the data in the observation
Provider Last Name	SUDA
	Individual professional last name
Provider First Name	RUSSELL
	Individual professional first name
Provider Middle Name	R
	Individual professional middle name
Provider Name Suffix Text	SR.
	The name suffix of the provider if the provider is an individual. The name suffix is a ''generation-related'' suffix, such as Jr., Sr., II, III, IV, or V.
Provider Gender	M
	The provider's gender if the provider is a person.
Provider Credential Text	MD
	The abbreviations for professional degrees or credentials used or held by the provider, if the provider is an individual. Examples are MD, DDS, CSW, CNA, AA, NP, RNA, or PSY. These credential designations will not be verified by NPS.

Medical School Information
Medical School Name	SAINT LOUIS UNIVERSITY SCHOOL OF MEDICINE
	Individual professional's medical school
Graduation Year	1978
	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	300 MOORESVILLE RD
	Group Practice or individual's line 1 address
City	KANNAPOLIS
	Group Practice or individual's city
State	NC
	Group Practice or individual's state
Zip Code	280810304
	Group Practice or individual's zip code (9 digits when available)

Hospital(s) Affiliation Information
Professional Accepts Medicare Assignment	Y