Physician Compare National (NPI:1467094821)

HEALTHCARE PROVIDER: DIANA MARMOLEJOS NP

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

Individual Professional Information
NPI	1467094821
	Unique healthcare provider (clinician) ID assigned by NPPES
PECOS UID	6204260979
	Unique individual clinician ID assigned by PECOS
Professional Enrollment ID	I20200106001556
	Unique ID for the individual professional enrollment that is the source for the data in the observation
Provider Last Name	MARMOLEJOS
	Individual professional last name
Provider First Name	DIANA
	Individual professional first 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	2019
	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	GOSHEN HEALTH SYSTEM 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	4880598572
	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	121
	Total number of individual professionals affiliated with the Group Practice based on Group Practice PAC ID
Line 1 Street Address	400 W LINCOLN AVE
	Group Practice or individual's line 1 address
City	GOSHEN
	Group Practice or individual's city
State	IN
	Group Practice or individual's state
Zip Code	465262413
	Group Practice or individual's zip code (9 digits when available)
Phone Number	5745337600
	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	150026
	Medicare CCN of hospital where individual professional provides service 1
Hospital Affiliation LBN 1	GOSHEN HOSPITAL
	Legal business name of hospital where individual professional provides service 1
Professional Accepts Medicare Assignment	Y