Physician Compare National (NPI:1699718148)

HEALTHCARE PROVIDER: JOSE E FUENTE 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	1699718148
	Unique healthcare provider (clinician) ID assigned by NPPES
PECOS UID	1557256765
	Unique individual clinician ID assigned by PECOS
Professional Enrollment ID	I20040217000775
	Unique ID for the individual professional enrollment that is the source for the data in the observation
Provider Last Name	FUENTE
	Individual professional last name
Provider First Name	JOSE
	Individual professional first name
Provider Middle Name	E
	Individual professional middle 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	OTHER
	Individual professional's medical school
Graduation Year	1989
	Individual professional's medical school graduation year
Primary Specialty	NEPHROLOGY
	Primary medical specialty reported by the individual professional in the selected enrollment
Secondary Specialty 1	FAMILY MEDICINE
	First secondary medical specialty reported by the individual professional in the selected enrollment
All Secondary Specialties	FAMILY MEDICINE
	All four secondary specialties reported by the individual professional in the selected enrollment, separated by commas

Practice Information
Line 1 Street Address	315 E WARWICK DR
	Group Practice or individual's line 1 address
Line 2 Street Address	SUITE F2
	Group Practice or individual's line 2 address
City	ALMA
	Group Practice or individual's city
State	MI
	Group Practice or individual's state
Zip Code	488011083
	Group Practice or individual's zip code (9 digits when available)

Hospital(s) Affiliation Information
Hospital Affiliation CCN 1	230030
	Medicare CCN of hospital where individual professional provides service 1
Hospital Affiliation LBN 1	MIDMICHIGAN MEDICAL CENTER-GRATIOT
	Legal business name of hospital where individual professional provides service 1
Hospital Affiliation CCN 2	230080
	Medicare CCN of hospital where individual professional provides service 2
Hospital Affiliation LBN 2	MCLAREN CENTRAL MICHIGAN
	Legal business name of hospital where individual professional provides service 2
Hospital Affiliation CCN 3	230180
	Medicare CCN of hospital where individual professional provides service 3
Hospital Affiliation LBN 3	MIDMICHIGAN MEDICAL CENTER-CLARE
	Legal business name of hospital where individual professional provides service 3
Hospital Affiliation CCN 4	230070
	Medicare CCN of hospital where individual professional provides service 4
Hospital Affiliation LBN 4	COVENANT MEDICAL CENTER
	Legal business name of hospital where individual professional provides service 4
Hospital Affiliation CCN 5	230208
	Medicare CCN of hospital where individual professional provides service 5
Hospital Affiliation LBN 5	SPARROW CARSON HOSPITAL
	Legal business name of hospital where individual professional provides service 5
Professional Accepts Medicare Assignment	Y

Physician Compare National (NPI:1699718148)

HEALTHCARE PROVIDER: JOSE E FUENTE M.D.

Individual Professional Information

Medical School Information

Practice Information

Hospital(s) Affiliation Information