Physician Compare National (NPI:1629415682)

HEALTHCARE PROVIDER: MATTHEW VARACALLO 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	1629415682
	Unique healthcare provider (clinician) ID assigned by NPPES
PECOS UID	7416209291
	Unique individual clinician ID assigned by PECOS
Professional Enrollment ID	I20190725000115
	Unique ID for the individual professional enrollment that is the source for the data in the observation
Provider Last Name	VARACALLO
	Individual professional last name
Provider First Name	MATTHEW
	Individual professional first name
Provider Middle Name	ALAN
	Individual professional middle name
Provider Gender	M
	The provider's gender if the provider is a person.

Medical School Information
Medical School Name	PENNSYLVANIA STATE UNIVERSITY COLLEGE OF MEDICINE
	Individual professional's medical school
Graduation Year	2013
	Individual professional's medical school graduation year
Primary Specialty	ORTHOPEDIC SURGERY
	Primary medical specialty reported by the individual professional in the selected enrollment

Practice Information
Organization Legal Name	KEYSTONE REHABILITATION SYSTEMS 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	7012826753
	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	55
	Total number of individual professionals affiliated with the Group Practice based on Group Practice PAC ID
Line 1 Street Address	433 MAIN ST
	Group Practice or individual's line 1 address
City	BROCKWAY
	Group Practice or individual's city
State	PA
	Group Practice or individual's state
Zip Code	158241337
	Group Practice or individual's zip code (9 digits when available)
Phone Number	8142658508
	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	390086
	Medicare CCN of hospital where individual professional provides service 1
Hospital Affiliation LBN 1	PENN HIGHLAND DUBOIS
	Legal business name of hospital where individual professional provides service 1
Hospital Affiliation CCN 2	391312
	Medicare CCN of hospital where individual professional provides service 2
Hospital Affiliation LBN 2	PENN HIGHLANDS BROOKVILLE
	Legal business name of hospital where individual professional provides service 2
Hospital Affiliation CCN 3	391315
	Medicare CCN of hospital where individual professional provides service 3
Hospital Affiliation LBN 3	PENN HIGHLANDS ELK
	Legal business name of hospital where individual professional provides service 3
Professional Accepts Medicare Assignment	Y