Physician Compare National (NPI:1457343576)

HEALTHCARE PROVIDER: RITA MARIA MEJIA-BRAECKEVELT 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	1457343576
	Unique healthcare provider (clinician) ID assigned by NPPES
PECOS UID	4284798067
	Unique individual clinician ID assigned by PECOS
Professional Enrollment ID	I20190730003495
	Unique ID for the individual professional enrollment that is the source for the data in the observation
Provider Last Name	SECK
	Individual professional last name
Provider First Name	RITA
	Individual professional first name
Provider Middle Name	MARIA
	Individual professional middle name
Provider Gender	F
	The provider's gender if the provider is a person.

Medical School Information
Medical School Name	MICHIGAN STATE UNIVERSITY COLLEGE OF OSTEOPATHIC MEDICINE
	Individual professional's medical school
Graduation Year	1984
	Individual professional's medical school graduation year
Primary Specialty	INTERNAL MEDICINE
	Primary medical specialty reported by the individual professional in the selected enrollment

Practice Information
Organization Legal Name	ALFARO LTD
	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	5890834733
	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	11
	Total number of individual professionals affiliated with the Group Practice based on Group Practice PAC ID
Line 1 Street Address	1925 WHIPPLE
	Group Practice or individual's line 1 address
Line 2 Street Address	SUITE 30
	Group Practice or individual's line 2 address
City	LOGANDALE
	Group Practice or individual's city
State	NV
	Group Practice or individual's state
Zip Code	89021
	Group Practice or individual's zip code (9 digits when available)
Phone Number	7023983621
	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	291307
	Medicare CCN of hospital where individual professional provides service 1
Hospital Affiliation LBN 1	MESA VIEW REGIONAL HOSPITAL
	Legal business name of hospital where individual professional provides service 1
Hospital Affiliation CCN 2	460021
	Medicare CCN of hospital where individual professional provides service 2
Hospital Affiliation LBN 2	DIXIE REGIONAL MEDICAL CENTER
	Legal business name of hospital where individual professional provides service 2
Professional Accepts Medicare Assignment	Y