Physician Compare National (NPI:1104053602)

HEALTHCARE PROVIDER: MARISSA RENEE GONZALEZ M.D.

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

Individual Professional Information
NPI	1104053602
	Unique healthcare provider (clinician) ID assigned by NPPES
PECOS UID	1850544420
	Unique individual clinician ID assigned by PECOS
Professional Enrollment ID	I20130430000446
	Unique ID for the individual professional enrollment that is the source for the data in the observation
Provider Last Name	GONZALEZ
	Individual professional last name
Provider First Name	MARISSA
	Individual professional first name
Provider Middle Name	RENEE
	Individual professional middle name
Provider Gender	F
	The provider's gender if the provider is a person.

Medical School Information
Medical School Name	UNIVERSITY OF TEXAS MEDICAL SCHOOL AT SAN ANTONIO
	Individual professional's medical school
Graduation Year	2008
	Individual professional's medical school graduation year
Primary Specialty	FAMILY MEDICINE
	Primary medical specialty reported by the individual professional in the selected enrollment

Practice Information
Organization Legal Name	MARISSA R GONZALEZ M.D. PLLC
	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	5294961074
	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	2
	Total number of individual professionals affiliated with the Group Practice based on Group Practice PAC ID
Line 1 Street Address	220 W HILLSIDE RD
	Group Practice or individual's line 1 address
Line 2 Street Address	4A
	Group Practice or individual's line 2 address
City	LAREDO
	Group Practice or individual's city
State	TX
	Group Practice or individual's state
Zip Code	780416903
	Group Practice or individual's zip code (9 digits when available)
Phone Number	9567266937
	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	450029
	Medicare CCN of hospital where individual professional provides service 1
Hospital Affiliation LBN 1	LAREDO MEDICAL CENTER
	Legal business name of hospital where individual professional provides service 1
Hospital Affiliation CCN 2	450643
	Medicare CCN of hospital where individual professional provides service 2
Hospital Affiliation LBN 2	DOCTORS HOSPITAL OF LAREDO
	Legal business name of hospital where individual professional provides service 2
Professional Accepts Medicare Assignment	Y