Physician Compare National (NPI:1063737856)

HEALTHCARE PROVIDER: FAUSTO ROBERTO CARRASQUILLO P.A.

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

Individual Professional Information
NPI	1063737856
	Unique healthcare provider (clinician) ID assigned by NPPES
PECOS UID	7618132994
	Unique individual clinician ID assigned by PECOS
Professional Enrollment ID	I20120712000265
	Unique ID for the individual professional enrollment that is the source for the data in the observation
Provider Last Name	CARRASQUILLO
	Individual professional last name
Provider First Name	FAUSTO
	Individual professional first name
Provider Middle Name	R
	Individual professional middle name
Provider Gender	M
	The provider's gender if the provider is a person.

Medical School Information
Medical School Name	OTHER
	Individual professional's medical school
Graduation Year	2009
	Individual professional's medical school graduation year
Primary Specialty	PHYSICIAN ASSISTANT
	Primary medical specialty reported by the individual professional in the selected enrollment

Practice Information
Organization Legal Name	PREMIER MEDICAL ASSOCIATES ALL FLORIDA LLC
	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	2365418019
	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	36
	Total number of individual professionals affiliated with the Group Practice based on Group Practice PAC ID
Line 1 Street Address	1225 W COUNTY RD
	Group Practice or individual's line 1 address
Line 2 Street Address	SUITE 48
	Group Practice or individual's line 2 address
City	BUSHNELL
	Group Practice or individual's city
State	FL
	Group Practice or individual's state
Zip Code	335138973
	Group Practice or individual's zip code (9 digits when available)
Phone Number	3522592159
	Phone number is listed only when there is a single phone number available for the practice location address

Hospital(s) Affiliation Information
Professional Accepts Medicare Assignment	Y