Physician Compare National (NPI:1205827136)

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	1205827136
	Unique healthcare provider (clinician) ID assigned by NPPES
PECOS UID	7618093899
	Unique individual clinician ID assigned by PECOS
Professional Enrollment ID	I20170227001537
	Unique ID for the individual professional enrollment that is the source for the data in the observation
Provider Last Name	LONGEVIN
	Individual professional last name
Provider First Name	MICHAEL
	Individual professional first name
Provider Middle Name	E
	Individual professional middle name
Provider Gender	M
	The provider's gender if the provider is a person.

Medical School Information
Medical School Name	UNIVERSITY OF CINCINNATI COLLEGE OF MEDICINE
	Individual professional's medical school
Graduation Year	1980
	Individual professional's medical school graduation year
Primary Specialty	UROLOGY
	Primary medical specialty reported by the individual professional in the selected enrollment

Practice Information
Organization Legal Name	ADVENTIST HEALTH PHYSICIANS NETWORK
	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	3274580972
	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	324
	Total number of individual professionals affiliated with the Group Practice based on Group Practice PAC ID
Line 1 Street Address	1142 ROSE AVE
	Group Practice or individual's line 1 address
Line 2 Street Address	SUITE B
	Group Practice or individual's line 2 address
City	SELMA
	Group Practice or individual's city
State	CA
	Group Practice or individual's state
Zip Code	936623251
	Group Practice or individual's zip code (9 digits when available)
Phone Number	5598566180
	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	050121
	Medicare CCN of hospital where individual professional provides service 1
Hospital Affiliation LBN 1	ADVENTIST HEALTH HANFORD
	Legal business name of hospital where individual professional provides service 1
Hospital Affiliation CCN 2	050192
	Medicare CCN of hospital where individual professional provides service 2
Hospital Affiliation LBN 2	ADVENTIST HEALTH REEDLEY
	Legal business name of hospital where individual professional provides service 2
Professional Accepts Medicare Assignment	Y