Physician Compare National (NPI:1497807853)

HEALTHCARE PROVIDER: KEINO ANDRE RUTHERFORD 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	1497807853
	Unique healthcare provider (clinician) ID assigned by NPPES
PECOS UID	0345438008
	Unique individual clinician ID assigned by PECOS
Professional Enrollment ID	I20101221001136
	Unique ID for the individual professional enrollment that is the source for the data in the observation
Provider Last Name	RUTHERFORD
	Individual professional last name
Provider First Name	KEINO
	Individual professional first name
Provider Middle Name	A
	Individual professional middle name
Provider Gender	M
	The provider's gender if the provider is a person.

Medical School Information
Medical School Name	HOWARD UNIVERSITY COLLEGE OF MEDICINE
	Individual professional's medical school
Graduation Year	1999
	Individual professional's medical school graduation year
Primary Specialty	INTERNAL MEDICINE
	Primary medical specialty reported by the individual professional in the selected enrollment

Practice Information
Organization Legal Name	EPIC MEDICAL GROUP, 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	4385883958
	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	25
	Total number of individual professionals affiliated with the Group Practice based on Group Practice PAC ID
Line 1 Street Address	5451 WALNUT AVE
	Group Practice or individual's line 1 address
City	CHINO
	Group Practice or individual's city
State	CA
	Group Practice or individual's state
Zip Code	917102609
	Group Practice or individual's zip code (9 digits when available)
Phone Number	9094648600
	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	050755
	Medicare CCN of hospital where individual professional provides service 1
Hospital Affiliation LBN 1	SHERMAN OAKS HOSPITAL
	Legal business name of hospital where individual professional provides service 1
Hospital Affiliation CCN 2	050586
	Medicare CCN of hospital where individual professional provides service 2
Hospital Affiliation LBN 2	CHINO VALLEY MEDICAL CENTER
	Legal business name of hospital where individual professional provides service 2
Hospital Affiliation CCN 3	050158
	Medicare CCN of hospital where individual professional provides service 3
Hospital Affiliation LBN 3	ENCINO HOSPITAL MEDICAL CENTER
	Legal business name of hospital where individual professional provides service 3
Professional Accepts Medicare Assignment	Y