Physician Compare National (NPI:1447289921)

HEALTHCARE PROVIDER: TONY T. MORENO II

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

Individual Professional Information
NPI	1447289921
	Unique healthcare provider (clinician) ID assigned by NPPES
PECOS UID	8628267713
	Unique individual clinician ID assigned by PECOS
Professional Enrollment ID	I20110105000193
	Unique ID for the individual professional enrollment that is the source for the data in the observation
Provider Last Name	MORENO
	Individual professional last name
Provider First Name	TONY
	Individual professional first name
Provider Gender	M
	The provider's gender if the provider is a person.

Medical School Information
Medical School Name	UNIVERSITY OF TEXAS MEDICAL BRANCH AT GALVESTON
	Individual professional's medical school
Graduation Year	1982
	Individual professional's medical school graduation year
Primary Specialty	PHYSICIAN ASSISTANT
	Primary medical specialty reported by the individual professional in the selected enrollment

Practice Information
Organization Legal Name	VIDA Y SALUD - HEALTH SYSTEMS, INC.
	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	8820127848
	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	5
	Total number of individual professionals affiliated with the Group Practice based on Group Practice PAC ID
Line 1 Street Address	308 S CESAR CHAVEZ AVE
	Group Practice or individual's line 1 address
City	CRYSTAL CITY
	Group Practice or individual's city
State	TX
	Group Practice or individual's state
Zip Code	788394200
	Group Practice or individual's zip code (9 digits when available)
Phone Number	8303742301
	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	451387
	Medicare CCN of hospital where individual professional provides service 1
Hospital Affiliation LBN 1	UVALDE MEMORIAL HOSPITAL
	Legal business name of hospital where individual professional provides service 1
Hospital Affiliation CCN 2	451390
	Medicare CCN of hospital where individual professional provides service 2
Hospital Affiliation LBN 2	DIMMIT REGIONAL HOSPITAL
	Legal business name of hospital where individual professional provides service 2
Professional Accepts Medicare Assignment	Y