Physician Compare National (NPI:1245427178)

HEALTHCARE PROVIDER: JUAN CARLOS LACAYO 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	1245427178
	Unique healthcare provider (clinician) ID assigned by NPPES
PECOS UID	1951583301
	Unique individual clinician ID assigned by PECOS
Professional Enrollment ID	I20111020000013
	Unique ID for the individual professional enrollment that is the source for the data in the observation
Provider Last Name	LACAYO
	Individual professional last name
Provider First Name	JUAN
	Individual professional first name
Provider Gender	M
	The provider's gender if the provider is a person.

Medical School Information
Medical School Name	MEDICAL COLLEGE OF GEORGIA SCHOOL OF MEDICINE
	Individual professional's medical school
Graduation Year	2004
	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	3535 HWY 81
	Group Practice or individual's line 1 address
City	LOGANVILLE
	Group Practice or individual's city
State	GA
	Group Practice or individual's state
Zip Code	300524336
	Group Practice or individual's zip code (9 digits when available)

Hospital(s) Affiliation Information
Hospital Affiliation CCN 1	110192
	Medicare CCN of hospital where individual professional provides service 1
Hospital Affiliation LBN 1	EASTSIDE MEDICAL CENTER
	Legal business name of hospital where individual professional provides service 1
Hospital Affiliation CCN 2	110091
	Medicare CCN of hospital where individual professional provides service 2
Hospital Affiliation LBN 2	PIEDMONT ROCKDALE HOSPITAL
	Legal business name of hospital where individual professional provides service 2
Hospital Affiliation CCN 3	110161
	Medicare CCN of hospital where individual professional provides service 3
Hospital Affiliation LBN 3	NORTHSIDE HOSPITAL
	Legal business name of hospital where individual professional provides service 3
Hospital Affiliation CCN 4	110046
	Medicare CCN of hospital where individual professional provides service 4
Hospital Affiliation LBN 4	CLEARVIEW REGIONAL MEDICAL CENTER
	Legal business name of hospital where individual professional provides service 4
Professional Accepts Medicare Assignment	Y