Physician Compare National (NPI:1124019427)

HEALTHCARE PROVIDER: VERNON P MONTOYA 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	1124019427
	Unique healthcare provider (clinician) ID assigned by NPPES
PECOS UID	5395729818
	Unique individual clinician ID assigned by PECOS
Professional Enrollment ID	I20040614001098
	Unique ID for the individual professional enrollment that is the source for the data in the observation
Provider Last Name	MONTOYA
	Individual professional last name
Provider First Name	VERNON
	Individual professional first name
Provider Middle Name	P
	Individual professional middle name
Provider Gender	M
	The provider's gender if the provider is a person.
Provider Credential Text	MD
	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	OTHER
	Individual professional's medical school
Graduation Year	1985
	Individual professional's medical school graduation year
Primary Specialty	MEDICAL ONCOLOGY
	Primary medical specialty reported by the individual professional in the selected enrollment
Secondary Specialty 1	HEMATOLOGY
	First secondary medical specialty reported by the individual professional in the selected enrollment
All Secondary Specialties	HEMATOLOGY
	All four secondary specialties reported by the individual professional in the selected enrollment, separated by commas

Practice Information
Organization Legal Name	LAKE CITY CANCER CARE 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	7315250685
	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	5
	Total number of individual professionals affiliated with the Group Practice based on Group Practice PAC ID
Line 1 Street Address	289 SW STONEGATE TER
	Group Practice or individual's line 1 address
Line 2 Street Address	SUITE 103
	Group Practice or individual's line 2 address
City	LAKE CITY
	Group Practice or individual's city
State	FL
	Group Practice or individual's state
Zip Code	320243457
	Group Practice or individual's zip code (9 digits when available)
Phone Number	3867551655
	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	100156
	Medicare CCN of hospital where individual professional provides service 1
Hospital Affiliation LBN 1	LAKE CITY MEDICAL CENTER
	Legal business name of hospital where individual professional provides service 1
Hospital Affiliation CCN 2	100102
	Medicare CCN of hospital where individual professional provides service 2
Hospital Affiliation LBN 2	SHANDS LAKE SHORE REGIONAL MEDICAL CENTER
	Legal business name of hospital where individual professional provides service 2
Professional Accepts Medicare Assignment	Y