Physician Compare National (NPI:1477537942)

HEALTHCARE PROVIDER: JUAN CARLOS PEQUENO MD

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

Individual Professional Information
NPI	1477537942
	Unique healthcare provider (clinician) ID assigned by NPPES
PECOS UID	5395716351
	Unique individual clinician ID assigned by PECOS
Professional Enrollment ID	I20090630000427
	Unique ID for the individual professional enrollment that is the source for the data in the observation
Provider Last Name	PEQUENO
	Individual professional last name
Provider First Name	JUAN
	Individual professional first name
Provider Middle Name	C
	Individual professional middle name
Provider Gender	M
	The provider's gender if the provider is a person.
Provider Credential Text	MD
	The abbreviations for professional degrees or credentials used or held by the provider, if the provider is an individual. Examples are MD, DDS, CSW, CNA, AA, NP, RNA, or PSY. These credential designations will not be verified by NPS.

Medical School Information
Medical School Name	OTHER
	Individual professional's medical school
Graduation Year	1986
	Individual professional's medical school graduation year
Primary Specialty	PSYCHIATRY
	Primary medical specialty reported by the individual professional in the selected enrollment

Practice Information
Organization Legal Name	COUNTY OF SAN BERNARDINO
	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	3870499130
	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	37
	Total number of individual professionals affiliated with the Group Practice based on Group Practice PAC ID
Line 1 Street Address	12625 HESPERIA RD
	Group Practice or individual's line 1 address
City	VICTORVILLE
	Group Practice or individual's city
State	CA
	Group Practice or individual's state
Zip Code	923957720
	Group Practice or individual's zip code (9 digits when available)
Phone Number	7609551777
	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	051323
	Medicare CCN of hospital where individual professional provides service 1
Hospital Affiliation LBN 1	COLORADO RIVER MEDICAL CENTER
	Legal business name of hospital where individual professional provides service 1
Professional Accepts Medicare Assignment	Y