Physician Compare National (NPI:1417428004)

HEALTHCARE PROVIDER: MARIA JUANITA RENDON MSN, FNP-BC

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

Individual Professional Information
NPI	1417428004
	Unique healthcare provider (clinician) ID assigned by NPPES
PECOS UID	3971844218
	Unique individual clinician ID assigned by PECOS
Professional Enrollment ID	I20190415000181
	Unique ID for the individual professional enrollment that is the source for the data in the observation
Provider Last Name	ELIZONDO
	Individual professional last name
Provider First Name	MARIA
	Individual professional first name
Provider Middle Name	JUANITA
	Individual professional middle name
Provider Gender	F
	The provider's gender if the provider is a person.

Medical School Information
Medical School Name	OTHER
	Individual professional's medical school
Graduation Year	2018
	Individual professional's medical school graduation year
Primary Specialty	NURSE PRACTITIONER
	Primary medical specialty reported by the individual professional in the selected enrollment

Practice Information
Organization Legal Name	MAVERICK EMERGENCY MEDICINE ASSOCIATES PA
	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	6002878337
	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	7
	Total number of individual professionals affiliated with the Group Practice based on Group Practice PAC ID
Line 1 Street Address	3333 N FOSTER MALDONADO BLVD
	Group Practice or individual's line 1 address
City	EAGLE PASS
	Group Practice or individual's city
State	TX
	Group Practice or individual's state
Zip Code	788525893
	Group Practice or individual's zip code (9 digits when available)
Phone Number	8307735321
	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	450092
	Medicare CCN of hospital where individual professional provides service 1
Hospital Affiliation LBN 1	FORT DUNCAN MEDICAL CENTER
	Legal business name of hospital where individual professional provides service 1
Hospital Affiliation CCN 2	451387
	Medicare CCN of hospital where individual professional provides service 2
Hospital Affiliation LBN 2	UVALDE MEMORIAL HOSPITAL
	Legal business name of hospital where individual professional provides service 2
Professional Accepts Medicare Assignment	Y