Physician Compare National (NPI:1225045156)

HEALTHCARE PROVIDER: DAVID MORENO 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	1225045156
	Unique healthcare provider (clinician) ID assigned by NPPES
PECOS UID	8426100892
	Unique individual clinician ID assigned by PECOS
Professional Enrollment ID	I20110510000229
	Unique ID for the individual professional enrollment that is the source for the data in the observation
Provider Last Name	MORENO
	Individual professional last name
Provider First Name	DAVID
	Individual professional first name
Provider Gender	M
	The provider's gender if the provider is a person.

Medical School Information
Medical School Name	UNIVERSITY OF ILLINOIS COLLEGE OF MED (CHI/PEOR/ROCK/CHM-URB)
	Individual professional's medical school
Graduation Year	1998
	Individual professional's medical school graduation year
Primary Specialty	INTERNAL MEDICINE
	Primary medical specialty reported by the individual professional in the selected enrollment

Practice Information
Line 1 Street Address	12142 CORTEZ BLVD
	Group Practice or individual's line 1 address
City	BROOKSVILLE
	Group Practice or individual's city
State	FL
	Group Practice or individual's state
Zip Code	346135575
	Group Practice or individual's zip code (9 digits when available)

Hospital(s) Affiliation Information
Hospital Affiliation CCN 1	100264
	Medicare CCN of hospital where individual professional provides service 1
Hospital Affiliation LBN 1	OAK HILL HOSPITAL
	Legal business name of hospital where individual professional provides service 1
Professional Accepts Medicare Assignment	Y