Physician Compare National (NPI:1063520021)

HEALTHCARE PROVIDER: JOHN M QUINONES DO

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

Individual Professional Information
NPI	1063520021
	Unique healthcare provider (clinician) ID assigned by NPPES
PECOS UID	5597714014
	Unique individual clinician ID assigned by PECOS
Professional Enrollment ID	I20050121000328
	Unique ID for the individual professional enrollment that is the source for the data in the observation
Provider Last Name	QUINONES
	Individual professional last name
Provider First Name	JOHN
	Individual professional first name
Provider Gender	M
	The provider's gender if the provider is a person.
Provider Credential Text	DO
	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	CHICAGO COLLEGE OF OSTEOPATHY
	Individual professional's medical school
Graduation Year	1984
	Individual professional's medical school graduation year
Primary Specialty	FAMILY MEDICINE
	Primary medical specialty reported by the individual professional in the selected enrollment
Secondary Specialty 1	EMERGENCY MEDICINE
	First secondary medical specialty reported by the individual professional in the selected enrollment
All Secondary Specialties	EMERGENCY MEDICINE
	All four secondary specialties reported by the individual professional in the selected enrollment, separated by commas

Practice Information
Organization Legal Name	MASON HOSPITAL DISTRICT
	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	2466360607
	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	22
	Total number of individual professionals affiliated with the Group Practice based on Group Practice PAC ID
Line 1 Street Address	615 N PROMENADE ST
	Group Practice or individual's line 1 address
City	HAVANA
	Group Practice or individual's city
State	IL
	Group Practice or individual's state
Zip Code	626441243
	Group Practice or individual's zip code (9 digits when available)
Phone Number	3095438542
	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	141313
	Medicare CCN of hospital where individual professional provides service 1
Hospital Affiliation LBN 1	MASON DISTRICT HOSPITAL
	Legal business name of hospital where individual professional provides service 1
Professional Accepts Medicare Assignment	Y