Physician Compare National (NPI:1407346927)

HEALTHCARE PROVIDER: JOSE RENE PENA DO

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

Individual Professional Information
NPI	1407346927
	Unique healthcare provider (clinician) ID assigned by NPPES
PECOS UID	9133554116
	Unique individual clinician ID assigned by PECOS
Professional Enrollment ID	I20200122000314
	Unique ID for the individual professional enrollment that is the source for the data in the observation
Provider Last Name	PENA
	Individual professional last name
Provider First Name	JOSE
	Individual professional first name
Provider Middle Name	R
	Individual professional middle name
Provider Name Suffix Text	III
	The name suffix of the provider if the provider is an individual. The name suffix is a ''generation-related'' suffix, such as Jr., Sr., II, III, IV, or V.
Provider Gender	M
	The provider's gender if the provider is a person.

Medical School Information
Medical School Name	UNIVERSITY OF NORTH TEXAS HSC, COLLEGE OF OSTEOPATHIC MED
	Individual professional's medical school
Graduation Year	2018
	Individual professional's medical school graduation year
Primary Specialty	FAMILY MEDICINE
	Primary medical specialty reported by the individual professional in the selected enrollment

Practice Information
Organization Legal Name	ST DAVIDS CARENOW URGENT CARE PLLC
	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	4284918418
	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	45
	Total number of individual professionals affiliated with the Group Practice based on Group Practice PAC ID
Line 1 Street Address	208 W BEN WHITE BLVD
	Group Practice or individual's line 1 address
City	AUSTIN
	Group Practice or individual's city
State	TX
	Group Practice or individual's state
Zip Code	787047126
	Group Practice or individual's zip code (9 digits when available)
Phone Number	5128618060
	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