Physician Compare National (NPI:1528043155)

HEALTHCARE PROVIDER:

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

Individual Professional Information
NPI	1528043155
	Unique healthcare provider (clinician) ID assigned by NPPES
PECOS UID	8224219423
	Unique individual clinician ID assigned by PECOS
Professional Enrollment ID	I20110222000196
	Unique ID for the individual professional enrollment that is the source for the data in the observation
Provider Last Name	GARVISH
	Individual professional last name
Provider First Name	JOHN
	Individual professional first name
Provider Gender	M
	The provider's gender if the provider is a person.

Medical School Information
Medical School Name	UNIVERSITY OF ILLINOIS COLLEGE OF MED (CHI/PEOR/ROCK/CHM-URB)
	Individual professional's medical school
Graduation Year	1965
	Individual professional's medical school graduation year
Primary Specialty	DIAGNOSTIC RADIOLOGY
	Primary medical specialty reported by the individual professional in the selected enrollment
Secondary Specialty 1	NUCLEAR MEDICINE
	First secondary medical specialty reported by the individual professional in the selected enrollment
All Secondary Specialties	NUCLEAR MEDICINE
	All four secondary specialties reported by the individual professional in the selected enrollment, separated by commas

Practice Information
Line 1 Street Address	2404 YONKERS
	Group Practice or individual's line 1 address
Line 2 Street Address	SUITE 4
	Group Practice or individual's line 2 address
City	PLAINVIEW
	Group Practice or individual's city
State	TX
	Group Practice or individual's state
Zip Code	790721820
	Group Practice or individual's zip code (9 digits when available)
Phone Number	8062934231
	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	451342
	Medicare CCN of hospital where individual professional provides service 1
Hospital Affiliation LBN 1	MITCHELL COUNTY HOSPITAL DISTRICT
	Legal business name of hospital where individual professional provides service 1
Professional Accepts Medicare Assignment	Y