Physician Compare National (NPI:1750880134)

HEALTHCARE PROVIDER: ROBERT GOMANN GENOVESE II PA-C

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

Individual Professional Information
NPI	1750880134
	Unique healthcare provider (clinician) ID assigned by NPPES
PECOS UID	5193088714
	Unique individual clinician ID assigned by PECOS
Professional Enrollment ID	I20180413000120
	Unique ID for the individual professional enrollment that is the source for the data in the observation
Provider Last Name	GENOVESE
	Individual professional last name
Provider First Name	ROBERT
	Individual professional first name
Provider Middle Name	GOMANN
	Individual professional middle name
Provider Name Suffix Text	II
	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	OTHER
	Individual professional's medical school
Graduation Year	2017
	Individual professional's medical school graduation year
Primary Specialty	PHYSICIAN ASSISTANT
	Primary medical specialty reported by the individual professional in the selected enrollment

Practice Information
Organization Legal Name	GEORGE RAYMOND WILLIAMS, M.D.
	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	5092606251
	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	3
	Total number of individual professionals affiliated with the Group Practice based on Group Practice PAC ID
Line 1 Street Address	1233 WAYNE GILMORE CIR
	Group Practice or individual's line 1 address
Line 2 Street Address	SUITE 250A
	Group Practice or individual's line 2 address
City	OPELOUSAS
	Group Practice or individual's city
State	LA
	Group Practice or individual's state
Zip Code	705706405
	Group Practice or individual's zip code (9 digits when available)
Phone Number	3379488556
	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	190017
	Medicare CCN of hospital where individual professional provides service 1
Hospital Affiliation LBN 1	OPELOUSAS GENERAL HEALTH SYSTEM
	Legal business name of hospital where individual professional provides service 1
Professional Accepts Medicare Assignment	Y