Physician Compare National (NPI:1023165503)

HEALTHCARE PROVIDER: BRUCE I GODEREZ 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	1023165503
	Unique healthcare provider (clinician) ID assigned by NPPES
PECOS UID	8729021993
	Unique individual clinician ID assigned by PECOS
Professional Enrollment ID	I20050608000629
	Unique ID for the individual professional enrollment that is the source for the data in the observation
Provider Last Name	GODEREZ
	Individual professional last name
Provider First Name	BRUCE
	Individual professional first name
Provider Middle Name	I
	Individual professional middle name
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	UNIVERSITY OF VIRGINIA SCHOOL OF MEDICINE
	Individual professional's medical school
Graduation Year	1976
	Individual professional's medical school graduation year
Primary Specialty	PSYCHIATRY
	Primary medical specialty reported by the individual professional in the selected enrollment

Practice Information
Line 1 Street Address	8 RIVER DR
	Group Practice or individual's line 1 address
City	HADLEY
	Group Practice or individual's city
State	MA
	Group Practice or individual's state
Zip Code	010353540
	Group Practice or individual's zip code (9 digits when available)

Hospital(s) Affiliation Information
Hospital Affiliation CCN 1	220077
	Medicare CCN of hospital where individual professional provides service 1
Hospital Affiliation LBN 1	BAYSTATE MEDICAL CENTER
	Legal business name of hospital where individual professional provides service 1
Hospital Affiliation CCN 2	220015
	Medicare CCN of hospital where individual professional provides service 2
Hospital Affiliation LBN 2	COOLEY DICKINSON HOSPITAL INC,THE
	Legal business name of hospital where individual professional provides service 2
Professional Accepts Medicare Assignment	M