Physician Compare National (NPI:1194131730)

HEALTHCARE PROVIDER: IVAN ALFONSO SAMCAM 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	1194131730
	Unique healthcare provider (clinician) ID assigned by NPPES
PECOS UID	1850510694
	Unique individual clinician ID assigned by PECOS
Professional Enrollment ID	I20170727001246
	Unique ID for the individual professional enrollment that is the source for the data in the observation
Provider Last Name	SAMCAM
	Individual professional last name
Provider First Name	IVAN
	Individual professional first name
Provider Gender	M
	The provider's gender if the provider is a person.

Medical School Information
Medical School Name	UNIVERSITY OF FLORIDA COLLEGE OF MEDICINE
	Individual professional's medical school
Graduation Year	2014
	Individual professional's medical school graduation year
Primary Specialty	EMERGENCY MEDICINE
	Primary medical specialty reported by the individual professional in the selected enrollment

Practice Information
Organization Legal Name	ADVANCED PAIN MANAGEMENT SPECIALISTS
	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	9638161979
	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	8255 COLLEGE PKWY
	Group Practice or individual's line 1 address
Line 2 Street Address	SUITE 200
	Group Practice or individual's line 2 address
City	FORT MYERS
	Group Practice or individual's city
State	FL
	Group Practice or individual's state
Zip Code	339195119
	Group Practice or individual's zip code (9 digits when available)
Phone Number	2393376888
	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	100244
	Medicare CCN of hospital where individual professional provides service 1
Hospital Affiliation LBN 1	CAPE CORAL HOSPITAL - 100244
	Legal business name of hospital where individual professional provides service 1
Hospital Affiliation CCN 2	100012
	Medicare CCN of hospital where individual professional provides service 2
Hospital Affiliation LBN 2	LEE MEMORIAL HOSPITAL
	Legal business name of hospital where individual professional provides service 2
Hospital Affiliation CCN 3	100018
	Medicare CCN of hospital where individual professional provides service 3
Hospital Affiliation LBN 3	NAPLES COMMUNITY HOSPITAL
	Legal business name of hospital where individual professional provides service 3
Professional Accepts Medicare Assignment	Y