Physician Compare National (NPI:1699749911)

HEALTHCARE PROVIDER: REUBEN M FARRIS 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	1699749911
	Unique healthcare provider (clinician) ID assigned by NPPES
PECOS UID	5294749628
	Unique individual clinician ID assigned by PECOS
Professional Enrollment ID	I20100506000926
	Unique ID for the individual professional enrollment that is the source for the data in the observation
Provider Last Name	FARRIS
	Individual professional last name
Provider First Name	REUBEN
	Individual professional first name
Provider Middle Name	MAX
	Individual professional middle name
Provider Name Suffix Text	JR.
	The name suffix of the provider if the provider is an individual. The name suffix is a ''generation-related'' suffix, such as Jr., Sr., II, III, IV, or V.
Provider Gender	M
	The provider's gender if the provider is a person.

Medical School Information
Medical School Name	UNIVERSITY OF MISSISSIPPI SCHOOL OF MEDICINE
	Individual professional's medical school
Graduation Year	1979
	Individual professional's medical school graduation year
Primary Specialty	FAMILY MEDICINE
	Primary medical specialty reported by the individual professional in the selected enrollment

Practice Information
Line 1 Street Address	340 4TH AVE
	Group Practice or individual's line 1 address
Line 2 Street Address	SUITE 2
	Group Practice or individual's line 2 address
City	CHULA VISTA
	Group Practice or individual's city
State	CA
	Group Practice or individual's state
Zip Code	919103883
	Group Practice or individual's zip code (9 digits when available)

Hospital(s) Affiliation Information
Hospital Affiliation CCN 1	050077
	Medicare CCN of hospital where individual professional provides service 1
Hospital Affiliation LBN 1	SCRIPPS MERCY HOSPITAL
	Legal business name of hospital where individual professional provides service 1
Hospital Affiliation CCN 2	050222
	Medicare CCN of hospital where individual professional provides service 2
Hospital Affiliation LBN 2	SHARP CHULA VISTA MEDICAL CENTER
	Legal business name of hospital where individual professional provides service 2
Professional Accepts Medicare Assignment	Y