Physician Compare National (NPI:1104898733)

HEALTHCARE PROVIDER: DOMINGO CHARDON 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	1104898733
	Unique healthcare provider (clinician) ID assigned by NPPES
PECOS UID	9537104740
	Unique individual clinician ID assigned by PECOS
Professional Enrollment ID	I20101217000393
	Unique ID for the individual professional enrollment that is the source for the data in the observation
Provider Last Name	CHARDON
	Individual professional last name
Provider First Name	DOMINGO
	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	1985
	Individual professional's medical school graduation year
Primary Specialty	PULMONARY DISEASE
	Primary medical specialty reported by the individual professional in the selected enrollment
Secondary Specialty 1	INTERNAL MEDICINE
	First secondary medical specialty reported by the individual professional in the selected enrollment
All Secondary Specialties	INTERNAL MEDICINE
	All four secondary specialties reported by the individual professional in the selected enrollment, separated by commas

Practice Information
Line 1 Street Address	909 AVE TITO CASTRO TORRE MEDICA SAN LUCAS
	Group Practice or individual's line 1 address
Line 2 Street Address	SUITE 514
	Group Practice or individual's line 2 address
City	PONCE
	Group Practice or individual's city
State	PR
	Group Practice or individual's state
Zip Code	007164728
	Group Practice or individual's zip code (9 digits when available)

Hospital(s) Affiliation Information
Hospital Affiliation CCN 1	400044
	Medicare CCN of hospital where individual professional provides service 1
Hospital Affiliation LBN 1	SAN LUKE'S MEMORIAL HOSPITAL INC
	Legal business name of hospital where individual professional provides service 1
Professional Accepts Medicare Assignment	Y