Physician Compare National (NPI:1164447983)

HEALTHCARE PROVIDER:

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

Individual Professional Information
NPI	1164447983
	Unique healthcare provider (clinician) ID assigned by NPPES
PECOS UID	7618007428
	Unique individual clinician ID assigned by PECOS
Professional Enrollment ID	I20100604000519
	Unique ID for the individual professional enrollment that is the source for the data in the observation
Provider Last Name	PILCO-JABER
	Individual professional last name
Provider First Name	RUTH
	Individual professional first name
Provider Middle Name	ESMERALDA
	Individual professional middle name
Provider Gender	F
	The provider's gender if the provider is a person.

Medical School Information
Medical School Name	OTHER
	Individual professional's medical school
Graduation Year	1981
	Individual professional's medical school graduation year
Primary Specialty	INTERNAL MEDICINE
	Primary medical specialty reported by the individual professional in the selected enrollment

Practice Information
Line 1 Street Address	3501 S SONCY RD
	Group Practice or individual's line 1 address
Line 2 Street Address	SUITE 131
	Group Practice or individual's line 2 address
City	AMARILLO
	Group Practice or individual's city
State	TX
	Group Practice or individual's state
Zip Code	791196406
	Group Practice or individual's zip code (9 digits when available)
Phone Number	8064679111
	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	450231
	Medicare CCN of hospital where individual professional provides service 1
Hospital Affiliation LBN 1	BAPTIST ST ANTHONY'S HOSPITAL
	Legal business name of hospital where individual professional provides service 1
Professional Accepts Medicare Assignment	Y