Physician Compare National (NPI:1043521719)

HEALTHCARE PROVIDER: GABRIEL CARDENAS JR. D.P.M.

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

Individual Professional Information
NPI	1043521719
	Unique healthcare provider (clinician) ID assigned by NPPES
PECOS UID	8426203191
	Unique individual clinician ID assigned by PECOS
Professional Enrollment ID	I20140801001524
	Unique ID for the individual professional enrollment that is the source for the data in the observation
Provider Last Name	CARDENAS
	Individual professional last name
Provider First Name	GABRIEL
	Individual professional first name
Provider Name Suffix Text	JR.
	The name suffix of the provider if the provider is an individual. The name suffix is a ''generation-related'' suffix, such as Jr., Sr., II, III, IV, or V.
Provider Gender	M
	The provider's gender if the provider is a person.

Medical School Information
Medical School Name	WILLIAM M. SCHOLL COLLEGE OF PODIATRIC MEDICINE
	Individual professional's medical school
Graduation Year	2010
	Individual professional's medical school graduation year
Primary Specialty	PODIATRY
	Primary medical specialty reported by the individual professional in the selected enrollment

Practice Information
Line 1 Street Address	6810 STATE ROUTE 162
	Group Practice or individual's line 1 address
Line 2 Street Address	SUITE 20
	Group Practice or individual's line 2 address
City	MARYVILLE
	Group Practice or individual's city
State	IL
	Group Practice or individual's state
Zip Code	620628587
	Group Practice or individual's zip code (9 digits when available)

Hospital(s) Affiliation Information
Hospital Affiliation CCN 1	140289
	Medicare CCN of hospital where individual professional provides service 1
Hospital Affiliation LBN 1	ANDERSON HOSPITAL
	Legal business name of hospital where individual professional provides service 1
Professional Accepts Medicare Assignment	Y