Physician Compare National (NPI:1194990424)

HEALTHCARE PROVIDER: UZODINMA RAPHAEL DIM 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	1194990424
	Unique healthcare provider (clinician) ID assigned by NPPES
PECOS UID	5395910145
	Unique individual clinician ID assigned by PECOS
Professional Enrollment ID	I20111207000221
	Unique ID for the individual professional enrollment that is the source for the data in the observation
Provider Last Name	DIM
	Individual professional last name
Provider First Name	UZODINMA
	Individual professional first name
Provider Middle Name	RAPHAEL
	Individual professional middle name
Provider Gender	M
	The provider's gender if the provider is a person.

Medical School Information
Medical School Name	COLLEGE OF MEDICINE AND SURGERY
	Individual professional's medical school
Graduation Year	1998
	Individual professional's medical school graduation year
Primary Specialty	CARDIOVASCULAR DISEASE (CARDIOLOGY)
	Primary medical specialty reported by the individual professional in the selected enrollment
Secondary Specialty 1	CARDIAC ELECTROPHYSIOLOGY
	First secondary medical specialty reported by the individual professional in the selected enrollment
Secondary Specialty 2	INTERNAL MEDICINE
	Second secondary medical specialty reported by the individual professional in the selected enrollment
Secondary Specialty 3	INTERVENTIONAL CARDIOLOGY
	Third secondary medical specialty reported by the individual professional in the selected enrollment
All Secondary Specialties	CARDIAC ELECTROPHYSIOLOGY, INTERNAL MEDICINE, INTERVENTIONAL CARDIOLOGY
	All four secondary specialties reported by the individual professional in the selected enrollment, separated by commas

Practice Information
Line 1 Street Address	2200 GEORGE DIETER DR
	Group Practice or individual's line 1 address
City	EL PASO
	Group Practice or individual's city
State	TX
	Group Practice or individual's state
Zip Code	799363915
	Group Practice or individual's zip code (9 digits when available)

Hospital(s) Affiliation Information
Hospital Affiliation CCN 1	450107
	Medicare CCN of hospital where individual professional provides service 1
Hospital Affiliation LBN 1	LAS PALMAS MEDICAL CENTER
	Legal business name of hospital where individual professional provides service 1
Hospital Affiliation CCN 2	450002
	Medicare CCN of hospital where individual professional provides service 2
Hospital Affiliation LBN 2	THE HOSPITALS OF PROVIDENCE - MEMORIAL CAMPUS
	Legal business name of hospital where individual professional provides service 2
Hospital Affiliation CCN 3	450668
	Medicare CCN of hospital where individual professional provides service 3
Hospital Affiliation LBN 3	THE HOSPITALS OF PROVIDENCE - SIERRA CAMPUS
	Legal business name of hospital where individual professional provides service 3
Professional Accepts Medicare Assignment	Y