Physician Compare National (NPI:1275792368)

HEALTHCARE PROVIDER: JOANNA KOPACZ MD

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

Individual Professional Information
NPI	1275792368
	Unique healthcare provider (clinician) ID assigned by NPPES
PECOS UID	1355515669
	Unique individual clinician ID assigned by PECOS
Professional Enrollment ID	I20140723001428
	Unique ID for the individual professional enrollment that is the source for the data in the observation
Provider Last Name	KOPACZ
	Individual professional last name
Provider First Name	JOANNA
	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	2004
	Individual professional's medical school graduation year
Primary Specialty	INFECTIOUS DISEASE
	Primary medical specialty reported by the individual professional in the selected enrollment
Secondary Specialty 1	GERIATRIC MEDICINE
	First secondary medical specialty reported by the individual professional in the selected enrollment
All Secondary Specialties	GERIATRIC MEDICINE
	All four secondary specialties reported by the individual professional in the selected enrollment, separated by commas

Practice Information
Line 1 Street Address	27800 MEDICAL CTR RD
	Group Practice or individual's line 1 address
Line 2 Street Address	SUITE 264
	Group Practice or individual's line 2 address
City	MISSION VIEJO
	Group Practice or individual's city
State	CA
	Group Practice or individual's state
Zip Code	926916447
	Group Practice or individual's zip code (9 digits when available)

Hospital(s) Affiliation Information
Hospital Affiliation CCN 1	050603
	Medicare CCN of hospital where individual professional provides service 1
Hospital Affiliation LBN 1	SADDLEBACK MEMORIAL MEDICAL CENTER
	Legal business name of hospital where individual professional provides service 1
Hospital Affiliation CCN 2	050567
	Medicare CCN of hospital where individual professional provides service 2
Hospital Affiliation LBN 2	MISSION HOSPITAL REGIONAL MED CENTER
	Legal business name of hospital where individual professional provides service 2
Professional Accepts Medicare Assignment	Y