Physician Compare National (NPI:1659442614)

HEALTHCARE PROVIDER: MAURICIO ACEVEDO 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	1659442614
	Unique healthcare provider (clinician) ID assigned by NPPES
PECOS UID	3678537693
	Unique individual clinician ID assigned by PECOS
Professional Enrollment ID	I20041118000446
	Unique ID for the individual professional enrollment that is the source for the data in the observation
Provider Last Name	ACEVEDO
	Individual professional last name
Provider First Name	MAURICIO
	Individual professional first name
Provider Gender	M
	The provider's gender if the provider is a person.
Provider Credential Text	MD
	The abbreviations for professional degrees or credentials used or held by the provider, if the provider is an individual. Examples are MD, DDS, CSW, CNA, AA, NP, RNA, or PSY. These credential designations will not be verified by NPS.

Medical School Information
Medical School Name	UNIVERSITY OF SOUTHERN CALIFORNIA KECK SCHOOL OF MEDICINE
	Individual professional's medical school
Graduation Year	1984
	Individual professional's medical school graduation year
Primary Specialty	EMERGENCY MEDICINE
	Primary medical specialty reported by the individual professional in the selected enrollment
Secondary Specialty 1	INTERNAL MEDICINE
	First secondary medical specialty reported by the individual professional in the selected enrollment
All Secondary Specialties	INTERNAL MEDICINE
	All four secondary specialties reported by the individual professional in the selected enrollment, separated by commas

Practice Information
Organization Legal Name	SOUTHERN CALIFORNIA PERMANENTE MEDICAL GROUP
	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	6002729175
	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	6474
	Total number of individual professionals affiliated with the Group Practice based on Group Practice PAC ID
Line 1 Street Address	1011 BALDWIN PARK BLVD
	Group Practice or individual's line 1 address
City	BALDWIN PARK
	Group Practice or individual's city
State	CA
	Group Practice or individual's state
Zip Code	917065806
	Group Practice or individual's zip code (9 digits when available)

Hospital(s) Affiliation Information
Hospital Affiliation CCN 1	050723
	Medicare CCN of hospital where individual professional provides service 1
Hospital Affiliation LBN 1	KAISER FOUNDATION HOSPITAL - BALDWIN PARK
	Legal business name of hospital where individual professional provides service 1
Professional Accepts Medicare Assignment	Y