Physician Compare National (NPI:1053723064)

HEALTHCARE PROVIDER: JOSEPH COLLINS D.O.

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

Individual Professional Information
NPI	1053723064
	Unique healthcare provider (clinician) ID assigned by NPPES
PECOS UID	3274888474
	Unique individual clinician ID assigned by PECOS
Professional Enrollment ID	I20180612000321
	Unique ID for the individual professional enrollment that is the source for the data in the observation
Provider Last Name	COLLINS
	Individual professional last name
Provider First Name	JOSEPH
	Individual professional first name
Provider Middle Name	CHARLES
	Individual professional middle name
Provider Gender	M
	The provider's gender if the provider is a person.

Medical School Information
Medical School Name	COLLEGE OF OSTEO MED OF THE PACIFIC AT POMONA
	Individual professional's medical school
Graduation Year	2014
	Individual professional's medical school graduation year
Primary Specialty	PHYSICAL MEDICINE AND REHABILITATION
	Primary medical specialty reported by the individual professional in the selected enrollment

Practice Information
Line 1 Street Address	150 VIA MERIDA
	Group Practice or individual's line 1 address
City	WESTLAKE VILLAGE
	Group Practice or individual's city
State	CA
	Group Practice or individual's state
Zip Code	913623816
	Group Practice or individual's zip code (9 digits when available)

Hospital(s) Affiliation Information
Hospital Affiliation CCN 1	050549
	Medicare CCN of hospital where individual professional provides service 1
Hospital Affiliation LBN 1	LOS ROBLES HOSPITAL & MEDICAL CENTER
	Legal business name of hospital where individual professional provides service 1
Professional Accepts Medicare Assignment	Y