Physician Compare National (NPI:1477612372)

HEALTHCARE PROVIDER: BRENT R DRISKILL M.D.

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

Individual Professional Information
NPI	1477612372
	Unique healthcare provider (clinician) ID assigned by NPPES
PECOS UID	0648402313
	Unique individual clinician ID assigned by PECOS
Professional Enrollment ID	I20170630001454
	Unique ID for the individual professional enrollment that is the source for the data in the observation
Provider Last Name	DRISKILL
	Individual professional last name
Provider First Name	BRENT
	Individual professional first name
Provider Middle Name	RAY
	Individual professional middle name
Provider Gender	M
	The provider's gender if the provider is a person.

Medical School Information
Medical School Name	UNIFORMED SERVICES UHS FE HEBERT SCHOOL OF MED
	Individual professional's medical school
Graduation Year	2005
	Individual professional's medical school graduation year
Primary Specialty	OTOLARYNGOLOGY
	Primary medical specialty reported by the individual professional in the selected enrollment

Practice Information
Line 1 Street Address	4033 3RD AVE
	Group Practice or individual's line 1 address
Line 2 Street Address	SUITE 104
	Group Practice or individual's line 2 address
City	SAN DIEGO
	Group Practice or individual's city
State	CA
	Group Practice or individual's state
Zip Code	921032136
	Group Practice or individual's zip code (9 digits when available)

Hospital(s) Affiliation Information
Hospital Affiliation CCN 1	050045
	Medicare CCN of hospital where individual professional provides service 1
Hospital Affiliation LBN 1	EL CENTRO REGIONAL MEDICAL CENTER
	Legal business name of hospital where individual professional provides service 1
Hospital Affiliation CCN 2	050077
	Medicare CCN of hospital where individual professional provides service 2
Hospital Affiliation LBN 2	SCRIPPS MERCY HOSPITAL
	Legal business name of hospital where individual professional provides service 2
Hospital Affiliation CCN 3	050222
	Medicare CCN of hospital where individual professional provides service 3
Hospital Affiliation LBN 3	SHARP CHULA VISTA MEDICAL CENTER
	Legal business name of hospital where individual professional provides service 3
Hospital Affiliation CCN 4	050026
	Medicare CCN of hospital where individual professional provides service 4
Hospital Affiliation LBN 4	GROSSMONT HOSPITAL
	Legal business name of hospital where individual professional provides service 4
Professional Accepts Medicare Assignment	Y