Physician Compare National (NPI:1649253790)

HEALTHCARE PROVIDER: HAROLD PAUL DIETZIUS 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	1649253790
	Unique healthcare provider (clinician) ID assigned by NPPES
PECOS UID	5597849646
	Unique individual clinician ID assigned by PECOS
Professional Enrollment ID	I20171113002771
	Unique ID for the individual professional enrollment that is the source for the data in the observation
Provider Last Name	DIETZIUS
	Individual professional last name
Provider First Name	HAROLD
	Individual professional first name
Provider Middle Name	P
	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	2002
	Individual professional's medical school graduation year
Primary Specialty	CARDIOVASCULAR DISEASE (CARDIOLOGY)
	Primary medical specialty reported by the individual professional in the selected enrollment

Practice Information
Organization Legal Name	STEWARD MEDICAL GROUP 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	2860688728
	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	1543
	Total number of individual professionals affiliated with the Group Practice based on Group Practice PAC ID
Line 1 Street Address	2100 CORCHESTER AVE
	Group Practice or individual's line 1 address
City	DORCHESTER
	Group Practice or individual's city
State	MA
	Group Practice or individual's state
Zip Code	021245615
	Group Practice or individual's zip code (9 digits when available)

Hospital(s) Affiliation Information
Hospital Affiliation CCN 1	220017
	Medicare CCN of hospital where individual professional provides service 1
Hospital Affiliation LBN 1	CARNEY HOSPITAL
	Legal business name of hospital where individual professional provides service 1
Hospital Affiliation CCN 2	220111
	Medicare CCN of hospital where individual professional provides service 2
Hospital Affiliation LBN 2	GOOD SAMARITAN MEDICAL CENTER
	Legal business name of hospital where individual professional provides service 2
Hospital Affiliation CCN 3	220036
	Medicare CCN of hospital where individual professional provides service 3
Hospital Affiliation LBN 3	ST ELIZABETH'S MEDICAL CENTER
	Legal business name of hospital where individual professional provides service 3
Professional Accepts Medicare Assignment	Y