Physician Compare National (NPI:1215258256)

HEALTHCARE PROVIDER: MICHELLE CARRILLO-MASSA 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	1215258256
	Unique healthcare provider (clinician) ID assigned by NPPES
PECOS UID	8628212792
	Unique individual clinician ID assigned by PECOS
Professional Enrollment ID	I20130912000212
	Unique ID for the individual professional enrollment that is the source for the data in the observation
Provider Last Name	CARRILLO-MASSA
	Individual professional last name
Provider First Name	MICHELLE
	Individual professional first name
Provider Gender	F
	The provider's gender if the provider is a person.

Medical School Information
Medical School Name	OTHER
	Individual professional's medical school
Graduation Year	2010
	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	GENERAL PRACTICE
	First secondary medical specialty reported by the individual professional in the selected enrollment
All Secondary Specialties	GENERAL PRACTICE
	All four secondary specialties reported by the individual professional in the selected enrollment, separated by commas

Practice Information
Line 1 Street Address	240 W INDIANTOWN RD
	Group Practice or individual's line 1 address
Line 2 Street Address	SUITE 102
	Group Practice or individual's line 2 address
City	JUPITER
	Group Practice or individual's city
State	FL
	Group Practice or individual's state
Zip Code	334583548
	Group Practice or individual's zip code (9 digits when available)

Hospital(s) Affiliation Information
Professional Accepts Medicare Assignment	Y