Physician Compare National (NPI:1205987914)

HEALTHCARE PROVIDER: MICHAEL ANTHONY BENAVIDEZ D.O.

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

Individual Professional Information
NPI	1205987914
	Unique healthcare provider (clinician) ID assigned by NPPES
PECOS UID	8527058759
	Unique individual clinician ID assigned by PECOS
Professional Enrollment ID	I20040521001214
	Unique ID for the individual professional enrollment that is the source for the data in the observation
Provider Last Name	BENAVIDEZ
	Individual professional last name
Provider First Name	MICHAEL
	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	COLLEGE OF OSTEO MED OF THE PACIFIC AT POMONA
	Individual professional's medical school
Graduation Year	1992
	Individual professional's medical school graduation year
Primary Specialty	FAMILY MEDICINE
	Primary medical specialty reported by the individual professional in the selected enrollment
Secondary Specialty 1	OSTEOPATHIC MANIPULATIVE MEDICINE
	First secondary medical specialty reported by the individual professional in the selected enrollment
All Secondary Specialties	OSTEOPATHIC MANIPULATIVE MEDICINE
	All four secondary specialties reported by the individual professional in the selected enrollment, separated by commas

Practice Information
Line 1 Street Address	984 W FOOTHILL BLVD
	Group Practice or individual's line 1 address
City	UPLAND
	Group Practice or individual's city
State	CA
	Group Practice or individual's state
Zip Code	917863700
	Group Practice or individual's zip code (9 digits when available)

Hospital(s) Affiliation Information
Hospital Affiliation CCN 1	050099
	Medicare CCN of hospital where individual professional provides service 1
Hospital Affiliation LBN 1	SAN ANTONIO REGIONAL HOSPITAL
	Legal business name of hospital where individual professional provides service 1
Hospital Affiliation CCN 2	050231
	Medicare CCN of hospital where individual professional provides service 2
Hospital Affiliation LBN 2	POMONA VALLEY HOSPITAL MEDICAL CENTER
	Legal business name of hospital where individual professional provides service 2
Professional Accepts Medicare Assignment	Y