Physician Compare National (NPI:1982882882)

HEALTHCARE PROVIDER: SANDEEP TIYYAGURA 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	1982882882
	Unique healthcare provider (clinician) ID assigned by NPPES
PECOS UID	5991837239
	Unique individual clinician ID assigned by PECOS
Professional Enrollment ID	I20100721000823
	Unique ID for the individual professional enrollment that is the source for the data in the observation
Provider Last Name	TIYYAGURA
	Individual professional last name
Provider First Name	SANDEEP
	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	2005
	Individual professional's medical school graduation year
Primary Specialty	NEPHROLOGY
	Primary medical specialty reported by the individual professional in the selected enrollment
Secondary Specialty 1	INTERNAL MEDICINE
	First secondary medical specialty reported by the individual professional in the selected enrollment
All Secondary Specialties	INTERNAL MEDICINE
	All four secondary specialties reported by the individual professional in the selected enrollment, separated by commas

Practice Information
Organization Legal Name	STAYWELL HEALTH CARE INC
	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	6305750480
	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	31
	Total number of individual professionals affiliated with the Group Practice based on Group Practice PAC ID
Line 1 Street Address	80 PHOENIX AVE
	Group Practice or individual's line 1 address
Line 2 Street Address	SUITE 201
	Group Practice or individual's line 2 address
City	WATERBURY
	Group Practice or individual's city
State	CT
	Group Practice or individual's state
Zip Code	067021418
	Group Practice or individual's zip code (9 digits when available)
Phone Number	2037575491
	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	070005
	Medicare CCN of hospital where individual professional provides service 1
Hospital Affiliation LBN 1	WATERBURY HOSPITAL
	Legal business name of hospital where individual professional provides service 1
Hospital Affiliation CCN 2	070016
	Medicare CCN of hospital where individual professional provides service 2
Hospital Affiliation LBN 2	SAINT MARYS HOSPITAL
	Legal business name of hospital where individual professional provides service 2
Hospital Affiliation CCN 3	070011
	Medicare CCN of hospital where individual professional provides service 3
Hospital Affiliation LBN 3	CHARLOTTE HUNGERFORD HOSPITAL
	Legal business name of hospital where individual professional provides service 3
Professional Accepts Medicare Assignment	Y