Physician Compare National (NPI:1215148606)

HEALTHCARE PROVIDER: JENNA CHRISTINA DISTASIO PA

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

Individual Professional Information
NPI	1215148606
	Unique healthcare provider (clinician) ID assigned by NPPES
PECOS UID	9638278625
	Unique individual clinician ID assigned by PECOS
Professional Enrollment ID	I20070615000097
	Unique ID for the individual professional enrollment that is the source for the data in the observation
Provider Last Name	DISTASIO
	Individual professional last name
Provider First Name	JENNA
	Individual professional first name
Provider Middle Name	C
	Individual professional middle name
Provider Gender	F
	The provider's gender if the provider is a person.

Medical School Information
Medical School Name	EASTERN VIRGINIA MEDICAL SCHOOL
	Individual professional's medical school
Graduation Year	2006
	Individual professional's medical school graduation year
Primary Specialty	PHYSICIAN ASSISTANT
	Primary medical specialty reported by the individual professional in the selected enrollment

Practice Information
Organization Legal Name	PRO SPORTS ORTHOPEDICS LLC
	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	8123301173
	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	8
	Total number of individual professionals affiliated with the Group Practice based on Group Practice PAC ID
Line 1 Street Address	20 GUEST ST
	Group Practice or individual's line 1 address
Line 2 Street Address	SUITE 225
	Group Practice or individual's line 2 address
City	BRIGHTON
	Group Practice or individual's city
State	MA
	Group Practice or individual's state
Zip Code	021352065
	Group Practice or individual's zip code (9 digits when available)
Phone Number	6177388642
	Phone number is listed only when there is a single phone number available for the practice location address

Hospital(s) Affiliation Information
Professional Accepts Medicare Assignment	Y