Physician Compare National (NPI:1770739260)

HEALTHCARE PROVIDER: WINSTON DACOSTA IRVING 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	1770739260
	Unique healthcare provider (clinician) ID assigned by NPPES
PECOS UID	4880859610
	Unique individual clinician ID assigned by PECOS
Professional Enrollment ID	I20131030001341
	Unique ID for the individual professional enrollment that is the source for the data in the observation
Provider Last Name	IRVING
	Individual professional last name
Provider First Name	WINSTON
	Individual professional first name
Provider Middle Name	D
	Individual professional middle name
Provider Gender	M
	The provider's gender if the provider is a person.

Medical School Information
Medical School Name	ALBERT EINSTEIN COLLEGE OF MEDICINE OF YESHIVA UNIVERSITY
	Individual professional's medical school
Graduation Year	2007
	Individual professional's medical school graduation year
Primary Specialty	DIAGNOSTIC RADIOLOGY
	Primary medical specialty reported by the individual professional in the selected enrollment

Practice Information
Line 1 Street Address	2090 W 1ST ST
	Group Practice or individual's line 1 address
Line 2 Street Address	APT 809
	Group Practice or individual's line 2 address
City	FORT MYERS
	Group Practice or individual's city
State	FL
	Group Practice or individual's state
Zip Code	339013115
	Group Practice or individual's zip code (9 digits when available)

Hospital(s) Affiliation Information
Hospital Affiliation CCN 1	100107
	Medicare CCN of hospital where individual professional provides service 1
Hospital Affiliation LBN 1	LEHIGH REGIONAL MEDICAL CENTER
	Legal business name of hospital where individual professional provides service 1
Hospital Affiliation CCN 2	100244
	Medicare CCN of hospital where individual professional provides service 2
Hospital Affiliation LBN 2	CAPE CORAL HOSPITAL - 100244
	Legal business name of hospital where individual professional provides service 2
Professional Accepts Medicare Assignment	Y