Physician Compare National (NPI:1093034084)

HEALTHCARE PROVIDER: ANTONIO JIMENEZ CHINEA MD

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

Individual Professional Information
NPI	1093034084
	Unique healthcare provider (clinician) ID assigned by NPPES
PECOS UID	3577876614
	Unique individual clinician ID assigned by PECOS
Professional Enrollment ID	I20190522001874
	Unique ID for the individual professional enrollment that is the source for the data in the observation
Provider Last Name	JIMENEZ
	Individual professional last name
Provider First Name	ANTONIO
	Individual professional first 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	NEPHROLOGY
	Primary medical specialty reported by the individual professional in the selected enrollment

Practice Information
Organization Legal Name	PUERTO RICO VASCULAR ACCESS CENTER PSC
	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	0941500011
	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	4
	Total number of individual professionals affiliated with the Group Practice based on Group Practice PAC ID
Line 1 Street Address	1 ST PARADA 37
	Group Practice or individual's line 1 address
City	SAN JUAN
	Group Practice or individual's city
State	PR
	Group Practice or individual's state
Zip Code	00918
	Group Practice or individual's zip code (9 digits when available)
Phone Number	7877583320
	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	400122
	Medicare CCN of hospital where individual professional provides service 1
Hospital Affiliation LBN 1	PROFESSIONAL HOSPITAL GUAYNABO INC
	Legal business name of hospital where individual professional provides service 1
Hospital Affiliation CCN 2	400016
	Medicare CCN of hospital where individual professional provides service 2
Hospital Affiliation LBN 2	AUXILIO MUTUO HOSPITAL
	Legal business name of hospital where individual professional provides service 2
Hospital Affiliation CCN 3	400004
	Medicare CCN of hospital where individual professional provides service 3
Hospital Affiliation LBN 3	ASOCIACION HOSPITAL DEL MAESTRO, INC
	Legal business name of hospital where individual professional provides service 3
Professional Accepts Medicare Assignment	Y