Physician Compare National (NPI:1295763381)

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	1295763381
	Unique healthcare provider (clinician) ID assigned by NPPES
PECOS UID	9537166285
	Unique individual clinician ID assigned by PECOS
Professional Enrollment ID	I20061023000371
	Unique ID for the individual professional enrollment that is the source for the data in the observation
Provider Last Name	PORTNOY
	Individual professional last name
Provider First Name	EDWARD
	Individual professional first name
Provider Middle Name	B
	Individual professional middle name
Provider Gender	M
	The provider's gender if the provider is a person.
Provider Credential Text	MD
	The abbreviations for professional degrees or credentials used or held by the provider, if the provider is an individual. Examples are MD, DDS, CSW, CNA, AA, NP, RNA, or PSY. These credential designations will not be verified by NPS.

Medical School Information
Medical School Name	STATE UNIVERSITY OF NEW YORK DOWNSTATE MEDICAL CENTER
	Individual professional's medical school
Graduation Year	1974
	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	1220 LA VENTA DR
	Group Practice or individual's line 1 address
Marker of address line 2 suppression	Y
	Marker that address as reported may be incomplete
City	WESTLAKE VILLAGE
	Group Practice or individual's city
State	CA
	Group Practice or individual's state
Zip Code	913613745
	Group Practice or individual's zip code (9 digits when available)
Phone Number	8054979272
	Phone number is listed only when there is a single phone number available for the practice location address

Hospital(s) Affiliation Information
Professional Accepts Medicare Assignment	Y