Physician Compare National (NPI:1720033152)

HEALTHCARE PROVIDER:

Physician Compare National contains general information about individual eligible professionals (EPs) such as demographic information and Medicare quality program participation.

Individual Professional Information
NPI	1720033152
	Unique healthcare provider (clinician) ID assigned by NPPES
PECOS UID	1850360553
	Unique individual clinician ID assigned by PECOS
Professional Enrollment ID	I20060508000152
	Unique ID for the individual professional enrollment that is the source for the data in the observation
Provider Last Name	VASTOLA
	Individual professional last name
Provider First Name	DAVID
	Individual professional first name
Provider Middle Name	L
	Individual professional middle name
Provider Gender	M
	The provider's gender if the provider is a person.
Provider Credential Text	DO
	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	CHICAGO COLLEGE OF OSTEOPATHY
	Individual professional's medical school
Graduation Year	1969
	Individual professional's medical school graduation year
Primary Specialty	INTERNAL MEDICINE
	Primary medical specialty reported by the individual professional in the selected enrollment
Secondary Specialty 1	GASTROENTEROLOGY
	First secondary medical specialty reported by the individual professional in the selected enrollment
All Secondary Specialties	GASTROENTEROLOGY
	All four secondary specialties reported by the individual professional in the selected enrollment, separated by commas

Practice Information
Line 1 Street Address	11000 PROSPERITY FARMS RD
	Group Practice or individual's line 1 address
Line 2 Street Address	SUITE 206
	Group Practice or individual's line 2 address
City	PALM BEACH GARDENS
	Group Practice or individual's city
State	FL
	Group Practice or individual's state
Zip Code	334103462
	Group Practice or individual's zip code (9 digits when available)

Hospital(s) Affiliation Information
Hospital Affiliation CCN 1	100176
	Medicare CCN of hospital where individual professional provides service 1
Hospital Affiliation LBN 1	PALM BEACH GARDENS MEDICAL CENTER
	Legal business name of hospital where individual professional provides service 1
Professional Accepts Medicare Assignment	Y