Physician Compare National (NPI:1396732442)

HEALTHCARE PROVIDER: GUSTAVO SERRANO 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	1396732442
	Unique healthcare provider (clinician) ID assigned by NPPES
PECOS UID	8921040833
	Unique individual clinician ID assigned by PECOS
Professional Enrollment ID	I20050601000357
	Unique ID for the individual professional enrollment that is the source for the data in the observation
Provider Last Name	SERRANO
	Individual professional last name
Provider First Name	GUSTAVO
	Individual professional first 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	UNIVERSITY OF PUERTO RICO SCHOOL OF MEDICINE
	Individual professional's medical school
Graduation Year	1987
	Individual professional's medical school graduation year
Primary Specialty	INTERNAL MEDICINE
	Primary medical specialty reported by the individual professional in the selected enrollment
Secondary Specialty 1	NEPHROLOGY
	First secondary medical specialty reported by the individual professional in the selected enrollment
All Secondary Specialties	NEPHROLOGY
	All four secondary specialties reported by the individual professional in the selected enrollment, separated by commas

Practice Information
Line 1 Street Address	5101 N ARMENIA AVE
	Group Practice or individual's line 1 address
Line 2 Street Address	SUITE A
	Group Practice or individual's line 2 address
City	TAMPA
	Group Practice or individual's city
State	FL
	Group Practice or individual's state
Zip Code	336031405
	Group Practice or individual's zip code (9 digits when available)
Phone Number	8138706477
	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	100206
	Medicare CCN of hospital where individual professional provides service 1
Hospital Affiliation LBN 1	MEMORIAL HOSPITAL OF TAMPA
	Legal business name of hospital where individual professional provides service 1
Hospital Affiliation CCN 2	100075
	Medicare CCN of hospital where individual professional provides service 2
Hospital Affiliation LBN 2	ST JOSEPHS HOSPITAL
	Legal business name of hospital where individual professional provides service 2
Professional Accepts Medicare Assignment	Y