Physician Compare National (NPI:1730479593)

HEALTHCARE PROVIDER: JOSE DIAZ 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	1730479593
	Unique healthcare provider (clinician) ID assigned by NPPES
PECOS UID	8325348808
	Unique individual clinician ID assigned by PECOS
Professional Enrollment ID	I20151207000352
	Unique ID for the individual professional enrollment that is the source for the data in the observation
Provider Last Name	DIAZ
	Individual professional last name
Provider First Name	JOSE
	Individual professional first name
Provider Middle Name	ANGEL
	Individual professional middle name
Provider Gender	M
	The provider's gender if the provider is a person.

Medical School Information
Medical School Name	UNIVERSITY OF TEXAS MEDICAL BRANCH AT GALVESTON
	Individual professional's medical school
Graduation Year	2011
	Individual professional's medical school graduation year
Primary Specialty	OBSTETRICS/GYNECOLOGY
	Primary medical specialty reported by the individual professional in the selected enrollment

Practice Information
Organization Legal Name	BON SECOURS MEDICAL GROUP RICHMOND SPECIALTY CARE LLC
	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	8022440056
	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	146
	Total number of individual professionals affiliated with the Group Practice based on Group Practice PAC ID
Line 1 Street Address	1501 MAPLE AVE
	Group Practice or individual's line 1 address
Line 2 Street Address	SUITE 100
	Group Practice or individual's line 2 address
City	RICHMOND
	Group Practice or individual's city
State	VA
	Group Practice or individual's state
Zip Code	232262553
	Group Practice or individual's zip code (9 digits when available)
Phone Number	8043202483
	Phone number is listed only when there is a single phone number available for the practice location address

Hospital(s) Affiliation Information
Hospital Affiliation CCN 1	490059
	Medicare CCN of hospital where individual professional provides service 1
Hospital Affiliation LBN 1	BON SECOURS ST MARYS HOSPITAL
	Legal business name of hospital where individual professional provides service 1
Professional Accepts Medicare Assignment	Y