Physician Compare National (NPI:1225039548)

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	1225039548
	Unique healthcare provider (clinician) ID assigned by NPPES
PECOS UID	9032249628
	Unique individual clinician ID assigned by PECOS
Professional Enrollment ID	I20100608000586
	Unique ID for the individual professional enrollment that is the source for the data in the observation
Provider Last Name	VIRGADAMO
	Individual professional last name
Provider First Name	VINCENZO
	Individual professional first 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	1968
	Individual professional's medical school graduation year
Primary Specialty	NEUROLOGY
	Primary medical specialty reported by the individual professional in the selected enrollment

Practice Information
Line 1 Street Address	6624 FANNIN ST
	Group Practice or individual's line 1 address
Line 2 Street Address	SUITE 2160
	Group Practice or individual's line 2 address
City	HOUSTON
	Group Practice or individual's city
State	TX
	Group Practice or individual's state
Zip Code	770302333
	Group Practice or individual's zip code (9 digits when available)

Hospital(s) Affiliation Information
Hospital Affiliation CCN 1	450193
	Medicare CCN of hospital where individual professional provides service 1
Hospital Affiliation LBN 1	CHI BAYLOR ST LUKES MEDICAL CENTER
	Legal business name of hospital where individual professional provides service 1
Professional Accepts Medicare Assignment	Y