Physician Compare National (NPI:1578641825)

HEALTHCARE PROVIDER: LUIS A. GONZALES 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	1578641825
	Unique healthcare provider (clinician) ID assigned by NPPES
PECOS UID	2163576257
	Unique individual clinician ID assigned by PECOS
Professional Enrollment ID	I20090825000323
	Unique ID for the individual professional enrollment that is the source for the data in the observation
Provider Last Name	GONZALES
	Individual professional last name
Provider First Name	LUIS
	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	OTHER
	Individual professional's medical school
Graduation Year	1983
	Individual professional's medical school graduation year
Primary Specialty	PSYCHIATRY
	Primary medical specialty reported by the individual professional in the selected enrollment

Practice Information
Organization Legal Name	PUERTO RICAN ORGANIZATION TO MOTIVATE, ENLIGHTEN AND SERVE ADDICTS 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	5395634539
	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	14
	Total number of individual professionals affiliated with the Group Practice based on Group Practice PAC ID
Line 1 Street Address	1776 CLAY AVE
	Group Practice or individual's line 1 address
City	BRONX
	Group Practice or individual's city
State	NY
	Group Practice or individual's state
Zip Code	104577239
	Group Practice or individual's zip code (9 digits when available)

Hospital(s) Affiliation Information
Hospital Affiliation CCN 1	330385
	Medicare CCN of hospital where individual professional provides service 1
Hospital Affiliation LBN 1	NORTH CENTRAL BRONX HOSPITAL
	Legal business name of hospital where individual professional provides service 1
Professional Accepts Medicare Assignment	Y