Physician Compare National (NPI:1306807862)

HEALTHCARE PROVIDER: SAMUEL AVON BERN 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	1306807862
	Unique healthcare provider (clinician) ID assigned by NPPES
PECOS UID	7214129055
	Unique individual clinician ID assigned by PECOS
Professional Enrollment ID	I20101012000297
	Unique ID for the individual professional enrollment that is the source for the data in the observation
Provider Last Name	BERN
	Individual professional last name
Provider First Name	SAMUEL
	Individual professional first name
Provider Middle Name	A
	Individual professional middle name
Provider Gender	M
	The provider's gender if the provider is a person.

Medical School Information
Medical School Name	YALE UNIVERSITY SCHOOL OF MEDICINE
	Individual professional's medical school
Graduation Year	1984
	Individual professional's medical school graduation year
Primary Specialty	PLASTIC AND RECONSTRUCTIVE SURGERY
	Primary medical specialty reported by the individual professional in the selected enrollment
Secondary Specialty 1	SURGICAL ONCOLOGY
	First secondary medical specialty reported by the individual professional in the selected enrollment
All Secondary Specialties	SURGICAL ONCOLOGY
	All four secondary specialties reported by the individual professional in the selected enrollment, separated by commas

Practice Information
Line 1 Street Address	1280 S VICTORIA AVE
	Group Practice or individual's line 1 address
Line 2 Street Address	SUITE 201
	Group Practice or individual's line 2 address
City	VENTURA
	Group Practice or individual's city
State	CA
	Group Practice or individual's state
Zip Code	930036551
	Group Practice or individual's zip code (9 digits when available)
Phone Number	8056421699
	Phone number is listed only when there is a single phone number available for the practice location address

Hospital(s) Affiliation Information
Hospital Affiliation CCN 1	050394
	Medicare CCN of hospital where individual professional provides service 1
Hospital Affiliation LBN 1	COMMUNITY MEMORIAL HOSPITAL SAN BUENAVENTURA
	Legal business name of hospital where individual professional provides service 1
Professional Accepts Medicare Assignment	Y