Physician Compare National (NPI:1740643238)

HEALTHCARE PROVIDER: ALICIA ORTIZ 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	1740643238
	Unique healthcare provider (clinician) ID assigned by NPPES
PECOS UID	5496048803
	Unique individual clinician ID assigned by PECOS
Professional Enrollment ID	I20190806000607
	Unique ID for the individual professional enrollment that is the source for the data in the observation
Provider Last Name	ORTIZ
	Individual professional last name
Provider First Name	ALICIA
	Individual professional first name
Provider Gender	F
	The provider's gender if the provider is a person.

Medical School Information
Medical School Name	LOUISIANA STATE UNIVERSITY SCHOOL OF MEDICINE IN SHREVEPORT
	Individual professional's medical school
Graduation Year	2016
	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
Organization Legal Name	BANNER HOSPITAL BASED PHYSICIANS COLORADO 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	6800031386
	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	73
	Total number of individual professionals affiliated with the Group Practice based on Group Practice PAC ID
Line 1 Street Address	1801 16TH ST
	Group Practice or individual's line 1 address
City	GREELEY
	Group Practice or individual's city
State	CO
	Group Practice or individual's state
Zip Code	806315154
	Group Practice or individual's zip code (9 digits when available)
Phone Number	9708104593
	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	060001
	Medicare CCN of hospital where individual professional provides service 1
Hospital Affiliation LBN 1	NORTH COLORADO MEDICAL CENTER
	Legal business name of hospital where individual professional provides service 1
Hospital Affiliation CCN 2	061303
	Medicare CCN of hospital where individual professional provides service 2
Hospital Affiliation LBN 2	EAST MORGAN COUNTY HOSPITAL
	Legal business name of hospital where individual professional provides service 2
Hospital Affiliation CCN 3	060010
	Medicare CCN of hospital where individual professional provides service 3
Hospital Affiliation LBN 3	POUDRE VALLEY HOSPITAL
	Legal business name of hospital where individual professional provides service 3
Professional Accepts Medicare Assignment	Y