Physician Compare National (NPI:1124174214)

HEALTHCARE PROVIDER: LUIS ALBERTO MEDINA AVILES 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	1124174214
	Unique healthcare provider (clinician) ID assigned by NPPES
PECOS UID	0648163162
	Unique individual clinician ID assigned by PECOS
Professional Enrollment ID	I20040206000532
	Unique ID for the individual professional enrollment that is the source for the data in the observation
Provider Last Name	MEDINA AVILES
	Individual professional last name
Provider First Name	LUIS
	Individual professional first name
Provider Middle Name	A
	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	1993
	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
Line 1 Street Address	CARR 638 KM
	Group Practice or individual's line 1 address
Line 2 Street Address	1 BO DOMINGO RUIZ
	Group Practice or individual's line 2 address
City	ARECIBO
	Group Practice or individual's city
State	PR
	Group Practice or individual's state
Zip Code	006129999
	Group Practice or individual's zip code (9 digits when available)
Phone Number	7878153239
	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	400117
	Medicare CCN of hospital where individual professional provides service 1
Hospital Affiliation LBN 1	HOSPITAL DR SUSONI INC
	Legal business name of hospital where individual professional provides service 1
Professional Accepts Medicare Assignment	Y