Physician Compare National (NPI:1376521740)

HEALTHCARE PROVIDER: MARK DAVID ZUBRES D.O.

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

Individual Professional Information
NPI	1376521740
	Unique healthcare provider (clinician) ID assigned by NPPES
PECOS UID	5092771634
	Unique individual clinician ID assigned by PECOS
Professional Enrollment ID	I20171117000531
	Unique ID for the individual professional enrollment that is the source for the data in the observation
Provider Last Name	ZUBRES
	Individual professional last name
Provider First Name	MARK
	Individual professional first name
Provider Middle Name	DAVID
	Individual professional middle name
Provider Gender	M
	The provider's gender if the provider is a person.
Provider Credential Text	DO
	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	MIDWESTERN UNIVERSITY, CHICAGO COLLEGE OF OSTEOPATHIC MED
	Individual professional's medical school
Graduation Year	1977
	Individual professional's medical school graduation year
Primary Specialty	DIAGNOSTIC RADIOLOGY
	Primary medical specialty reported by the individual professional in the selected enrollment

Practice Information
Organization Legal Name	EMPIRE STATE RADIOLOGY PC
	Legal name of the Group Practice that the individual professional works with- will be blank if the address is not linked to a Group Practice
Group Practice PAC ID	4385075241
	Unique Group Practice ID assigned by PECOS to the Group Practice that the individual professional works with- will be blank if the address is not linked to a Group Practice
Number of Group Practice members	29
	Total number of individual professionals affiliated with the Group Practice based on Group Practice PAC ID
Line 1 Street Address	1 ALTURA VIS
	Group Practice or individual's line 1 address
City	SANTA FE
	Group Practice or individual's city
State	NM
	Group Practice or individual's state
Zip Code	875077771
	Group Practice or individual's zip code (9 digits when available)
Phone Number	5613662002
	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	330259
	Medicare CCN of hospital where individual professional provides service 1
Hospital Affiliation LBN 1	MERCY MEDICAL CENTER
	Legal business name of hospital where individual professional provides service 1
Hospital Affiliation CCN 2	330332
	Medicare CCN of hospital where individual professional provides service 2
Hospital Affiliation LBN 2	CHSLI ST JOSEPH HOSPITAL
	Legal business name of hospital where individual professional provides service 2
Hospital Affiliation CCN 3	330106
	Medicare CCN of hospital where individual professional provides service 3
Hospital Affiliation LBN 3	NS/LIJ HS-NORTH SHORE UNIVERSITY HOSPITAL AT MANHASSET
	Legal business name of hospital where individual professional provides service 3
Professional Accepts Medicare Assignment	Y