Physician Compare National (NPI:1497118772)

HEALTHCARE PROVIDER: CORY DONOVAN BOVENZI 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	1497118772
	Unique healthcare provider (clinician) ID assigned by NPPES
PECOS UID	4880984830
	Unique individual clinician ID assigned by PECOS
Professional Enrollment ID	I20190405002235
	Unique ID for the individual professional enrollment that is the source for the data in the observation
Provider Last Name	BOVENZI
	Individual professional last name
Provider First Name	CORY
	Individual professional first name
Provider Middle Name	DONOVAN
	Individual professional middle name
Provider Gender	M
	The provider's gender if the provider is a person.

Medical School Information
Medical School Name	JEFFERSON MEDICAL COLLEGE OF THOMAS JEFFERSON UNIVERSITY
	Individual professional's medical school
Graduation Year	2016
	Individual professional's medical school graduation year
Primary Specialty	INTERNAL MEDICINE
	Primary medical specialty reported by the individual professional in the selected enrollment
Secondary Specialty 1	PLASTIC AND RECONSTRUCTIVE SURGERY
	First secondary medical specialty reported by the individual professional in the selected enrollment
All Secondary Specialties	PLASTIC AND RECONSTRUCTIVE SURGERY
	All four secondary specialties reported by the individual professional in the selected enrollment, separated by commas

Practice Information
Organization Legal Name	KND DEVELOPMENT 59 LLC
	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	3678602802
	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	134
	Total number of individual professionals affiliated with the Group Practice based on Group Practice PAC ID
Line 1 Street Address	1930 S BROAD ST
	Group Practice or individual's line 1 address
City	PHILADELPHIA
	Group Practice or individual's city
State	PA
	Group Practice or individual's state
Zip Code	191452328
	Group Practice or individual's zip code (9 digits when available)
Phone Number	2675705200
	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