Physician Compare National (NPI:1205989191)

HEALTHCARE PROVIDER: RICHARD MONTILLA 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	1205989191
	Unique healthcare provider (clinician) ID assigned by NPPES
PECOS UID	9830281625
	Unique individual clinician ID assigned by PECOS
Professional Enrollment ID	I20070824000287
	Unique ID for the individual professional enrollment that is the source for the data in the observation
Provider Last Name	MONTILLA
	Individual professional last name
Provider First Name	RICHARD
	Individual professional first name
Provider Middle Name	V
	Individual professional middle name
Provider Gender	M
	The provider's gender if the provider is a person.

Medical School Information
Medical School Name	OTHER
	Individual professional's medical school
Graduation Year	1995
	Individual professional's medical school graduation year
Primary Specialty	HAND SURGERY
	Primary medical specialty reported by the individual professional in the selected enrollment
Secondary Specialty 1	PLASTIC AND RECONSTRUCTIVE SURGERY
	First secondary medical specialty reported by the individual professional in the selected enrollment
All Secondary Specialties	PLASTIC AND RECONSTRUCTIVE SURGERY
	All four secondary specialties reported by the individual professional in the selected enrollment, separated by commas

Practice Information
Line 1 Street Address	299 LINCOLN ST
	Group Practice or individual's line 1 address
Line 2 Street Address	SUITE 201
	Group Practice or individual's line 2 address
City	WORCESTER
	Group Practice or individual's city
State	MA
	Group Practice or individual's state
Zip Code	016053646
	Group Practice or individual's zip code (9 digits when available)

Hospital(s) Affiliation Information
Hospital Affiliation CCN 1	221300
	Medicare CCN of hospital where individual professional provides service 1
Hospital Affiliation LBN 1	MARTHA'S VINEYARD HOSPITAL INC
	Legal business name of hospital where individual professional provides service 1
Hospital Affiliation CCN 2	220176
	Medicare CCN of hospital where individual professional provides service 2
Hospital Affiliation LBN 2	ST VINCENT HOSPITAL
	Legal business name of hospital where individual professional provides service 2
Hospital Affiliation CCN 3	220163
	Medicare CCN of hospital where individual professional provides service 3
Hospital Affiliation LBN 3	UMASS MEMORIAL MEDICAL CENTER/UNIVERSITY CAMPUS
	Legal business name of hospital where individual professional provides service 3
Professional Accepts Medicare Assignment	Y