Physician Compare National (NPI:1306072004)

HEALTHCARE PROVIDER: OMAR HORACIO HENRIQUEZ 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	1306072004
	Unique healthcare provider (clinician) ID assigned by NPPES
PECOS UID	2163650391
	Unique individual clinician ID assigned by PECOS
Professional Enrollment ID	I20140707001182
	Unique ID for the individual professional enrollment that is the source for the data in the observation
Provider Last Name	HENRIQUEZ
	Individual professional last name
Provider First Name	OMAR
	Individual professional first name
Provider Middle Name	H
	Individual professional middle name
Provider Gender	M
	The provider's gender if the provider is a person.

Medical School Information
Medical School Name	UNIVERSITY OF SOUTH FLORIDA COLLEGE OF MEDICINE
	Individual professional's medical school
Graduation Year	2009
	Individual professional's medical school graduation year
Primary Specialty	PAIN MANAGEMENT
	Primary medical specialty reported by the individual professional in the selected enrollment
Secondary Specialty 1	ANESTHESIOLOGY
	First secondary medical specialty reported by the individual professional in the selected enrollment
All Secondary Specialties	ANESTHESIOLOGY
	All four secondary specialties reported by the individual professional in the selected enrollment, separated by commas

Practice Information
Line 1 Street Address	1525 TAMIAMI TRL S
	Group Practice or individual's line 1 address
Line 2 Street Address	SUITE 601
	Group Practice or individual's line 2 address
City	VENICE
	Group Practice or individual's city
State	FL
	Group Practice or individual's state
Zip Code	342853568
	Group Practice or individual's zip code (9 digits when available)

Hospital(s) Affiliation Information
Hospital Affiliation CCN 1	100070
	Medicare CCN of hospital where individual professional provides service 1
Hospital Affiliation LBN 1	VENICE REGIONAL BAYFRONT HEALTH
	Legal business name of hospital where individual professional provides service 1
Professional Accepts Medicare Assignment	Y