Physician Compare National (NPI:1003973397)

HEALTHCARE PROVIDER: G. MICHAEL LOPEZ 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	1003973397
	Unique healthcare provider (clinician) ID assigned by NPPES
PECOS UID	3678753779
	Unique individual clinician ID assigned by PECOS
Professional Enrollment ID	I20110207000751
	Unique ID for the individual professional enrollment that is the source for the data in the observation
Provider Last Name	LOPEZ
	Individual professional last name
Provider First Name	G. MICHAEL
	Individual professional first name
Provider Gender	M
	The provider's gender if the provider is a person.

Medical School Information
Medical School Name	STANFORD UNIVERSITY SCHOOL OF MEDICINE
	Individual professional's medical school
Graduation Year	1978
	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	105 MILLS AVE
	Group Practice or individual's line 1 address
Line 2 Street Address	SUITE 300
	Group Practice or individual's line 2 address
City	LAS VEGAS
	Group Practice or individual's city
State	NM
	Group Practice or individual's state
Zip Code	877014169
	Group Practice or individual's zip code (9 digits when available)
Phone Number	5054259311
	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	320002
	Medicare CCN of hospital where individual professional provides service 1
Hospital Affiliation LBN 1	CHRISTUS ST VINCENT REGIONAL MEDICAL CENTER
	Legal business name of hospital where individual professional provides service 1
Hospital Affiliation CCN 2	320003
	Medicare CCN of hospital where individual professional provides service 2
Hospital Affiliation LBN 2	ALTA VISTA REGIONAL HOSPITAL
	Legal business name of hospital where individual professional provides service 2
Professional Accepts Medicare Assignment	Y