Physician Compare National (NPI:1629218235)

HEALTHCARE PROVIDER: ANGEL LUIS RIVERA D.O.

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

Individual Professional Information
NPI	1629218235
	Unique healthcare provider (clinician) ID assigned by NPPES
PECOS UID	5395962450
	Unique individual clinician ID assigned by PECOS
Professional Enrollment ID	I20140813001626
	Unique ID for the individual professional enrollment that is the source for the data in the observation
Provider Last Name	RIVERA
	Individual professional last name
Provider First Name	ANGEL
	Individual professional first name
Provider Middle Name	LUIS
	Individual professional middle name
Provider Gender	M
	The provider's gender if the provider is a person.

Medical School Information
Medical School Name	NOVA SOUTHEASTERN COLLEGE OF OSTEO MEDICINE
	Individual professional's medical school
Graduation Year	2008
	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	I2 MEDICINE 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	4789914920
	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	3
	Total number of individual professionals affiliated with the Group Practice based on Group Practice PAC ID
Line 1 Street Address	939 W N AVE
	Group Practice or individual's line 1 address
Line 2 Street Address	SUITE 650
	Group Practice or individual's line 2 address
City	CHICAGO
	Group Practice or individual's city
State	IL
	Group Practice or individual's state
Zip Code	606421231
	Group Practice or individual's zip code (9 digits when available)
Phone Number	7733778000
	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	140242
	Medicare CCN of hospital where individual professional provides service 1
Hospital Affiliation LBN 1	CENTRAL DUPAGE HOSPITAL
	Legal business name of hospital where individual professional provides service 1
Hospital Affiliation CCN 2	140114
	Medicare CCN of hospital where individual professional provides service 2
Hospital Affiliation LBN 2	SWEDISH COVENANT HOSPITAL
	Legal business name of hospital where individual professional provides service 2
Professional Accepts Medicare Assignment	Y