Physician Compare National (NPI:1992023188)

HEALTHCARE PROVIDER: TIMOTHY ALLAN GONG M.D.

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

Individual Professional Information
NPI	1992023188
	Unique healthcare provider (clinician) ID assigned by NPPES
PECOS UID	6406158831
	Unique individual clinician ID assigned by PECOS
Professional Enrollment ID	I20170829003832
	Unique ID for the individual professional enrollment that is the source for the data in the observation
Provider Last Name	GONG
	Individual professional last name
Provider First Name	TIMOTHY
	Individual professional first name
Provider Middle Name	A
	Individual professional middle name
Provider Gender	M
	The provider's gender if the provider is a person.

Medical School Information
Medical School Name	SAINT LOUIS UNIVERSITY SCHOOL OF MEDICINE
	Individual professional's medical school
Graduation Year	2010
	Individual professional's medical school graduation year
Primary Specialty	CARDIOVASCULAR DISEASE (CARDIOLOGY)
	Primary medical specialty reported by the individual professional in the selected enrollment

Practice Information
Line 1 Street Address	3500 GASTON AVE
	Group Practice or individual's line 1 address
City	DALLAS
	Group Practice or individual's city
State	TX
	Group Practice or individual's state
Zip Code	752462017
	Group Practice or individual's zip code (9 digits when available)
Phone Number	4698014600
	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	450021
	Medicare CCN of hospital where individual professional provides service 1
Hospital Affiliation LBN 1	BAYLOR UNIVERSITY MEDICAL CENTER
	Legal business name of hospital where individual professional provides service 1
Hospital Affiliation CCN 2	450851
	Medicare CCN of hospital where individual professional provides service 2
Hospital Affiliation LBN 2	BAYLOR SCOTT & WHITE HEART & VASCULAR HOSPITAL - DALLAS
	Legal business name of hospital where individual professional provides service 2
Professional Accepts Medicare Assignment	Y