Physician Compare National (NPI:1992961494)

HEALTHCARE PROVIDER: SAMIR RAJENDRA SHAH 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	1992961494
	Unique healthcare provider (clinician) ID assigned by NPPES
PECOS UID	6608022686
	Unique individual clinician ID assigned by PECOS
Professional Enrollment ID	I20120807000403
	Unique ID for the individual professional enrollment that is the source for the data in the observation
Provider Last Name	SHAH
	Individual professional last name
Provider First Name	SAMIR
	Individual professional first name
Provider Middle Name	RAJENDRA
	Individual professional middle 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	HAND SURGERY
	Primary medical specialty reported by the individual professional in the selected enrollment
Secondary Specialty 1	PLASTIC AND RECONSTRUCTIVE SURGERY
	First secondary medical specialty reported by the individual professional in the selected enrollment
All Secondary Specialties	PLASTIC AND RECONSTRUCTIVE SURGERY
	All four secondary specialties reported by the individual professional in the selected enrollment, separated by commas

Practice Information
Organization Legal Name	MIDWEST HAND SURGERY SC
	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	5597945857
	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	3
	Total number of individual professionals affiliated with the Group Practice based on Group Practice PAC ID
Line 1 Street Address	701 WINTHROP AVE
	Group Practice or individual's line 1 address
City	GLENDALE
	Group Practice or individual's city
State	IL
	Group Practice or individual's state
Zip Code	601391405
	Group Practice or individual's zip code (9 digits when available)
Phone Number	6305458000
	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	140062
	Medicare CCN of hospital where individual professional provides service 1
Hospital Affiliation LBN 1	PALOS COMMUNITY HOSPITAL
	Legal business name of hospital where individual professional provides service 1
Professional Accepts Medicare Assignment	Y