Physician Compare National (NPI:1467785014)

HEALTHCARE PROVIDER: ANGELITO DARIEL TACDERAS APN

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

Individual Professional Information
NPI	1467785014
	Unique healthcare provider (clinician) ID assigned by NPPES
PECOS UID	6406987643
	Unique individual clinician ID assigned by PECOS
Professional Enrollment ID	I20100701000503
	Unique ID for the individual professional enrollment that is the source for the data in the observation
Provider Last Name	TACDERAS
	Individual professional last name
Provider First Name	ANGELITO
	Individual professional first name
Provider Gender	M
	The provider's gender if the provider is a person.

Medical School Information
Medical School Name	OTHER
	Individual professional's medical school
Graduation Year	2009
	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	ADVANCED KIDNEY INSTITUTE, L.L.C.
	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	5991743262
	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	2
	Total number of individual professionals affiliated with the Group Practice based on Group Practice PAC ID
Line 1 Street Address	3405 OFFICE PARK DR
	Group Practice or individual's line 1 address
City	MARION
	Group Practice or individual's city
State	IL
	Group Practice or individual's state
Zip Code	629596478
	Group Practice or individual's zip code (9 digits when available)
Phone Number	6189978412
	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