Physician Compare National (NPI:1548336605)

HEALTHCARE PROVIDER: WALTER FRANCIS D'COSTA D.P.M.

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

Individual Professional Information
NPI	1548336605
	Unique healthcare provider (clinician) ID assigned by NPPES
PECOS UID	4486764396
	Unique individual clinician ID assigned by PECOS
Professional Enrollment ID	I20120227000069
	Unique ID for the individual professional enrollment that is the source for the data in the observation
Provider Last Name	D COSTA
	Individual professional last name
Provider First Name	WALTER
	Individual professional first name
Provider Gender	M
	The provider's gender if the provider is a person.

Medical School Information
Medical School Name	CALIFORNIA SCHOOL OF PODIATRIC MEDICINE
	Individual professional's medical school
Graduation Year	1980
	Individual professional's medical school graduation year
Primary Specialty	PODIATRY
	Primary medical specialty reported by the individual professional in the selected enrollment

Practice Information
Line 1 Street Address	2281 CLEVELAND AVE
	Group Practice or individual's line 1 address
City	SANTA ROSA
	Group Practice or individual's city
State	CA
	Group Practice or individual's state
Zip Code	954032905
	Group Practice or individual's zip code (9 digits when available)
Phone Number	7075443337
	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	050291
	Medicare CCN of hospital where individual professional provides service 1
Hospital Affiliation LBN 1	SUTTER SANTA ROSA REGIONAL HOSPITAL
	Legal business name of hospital where individual professional provides service 1
Hospital Affiliation CCN 2	050174
	Medicare CCN of hospital where individual professional provides service 2
Hospital Affiliation LBN 2	SANTA ROSA MEMORIAL HOSPITAL
	Legal business name of hospital where individual professional provides service 2
Hospital Affiliation CCN 3	051310
	Medicare CCN of hospital where individual professional provides service 3
Hospital Affiliation LBN 3	ADVENTIST HEALTH HOWARD MEMORIAL
	Legal business name of hospital where individual professional provides service 3
Professional Accepts Medicare Assignment	Y