Physician Compare National (NPI:1770773434)

HEALTHCARE PROVIDER: GUSTAVO ANTONIO MONDRAGON JR. M.D.

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

Individual Professional Information
NPI	1770773434
	Unique healthcare provider (clinician) ID assigned by NPPES
PECOS UID	7810151610
	Unique individual clinician ID assigned by PECOS
Professional Enrollment ID	I20120606000759
	Unique ID for the individual professional enrollment that is the source for the data in the observation
Provider Last Name	MONDRAGON
	Individual professional last name
Provider First Name	GUSTAVO
	Individual professional first name
Provider Middle Name	A
	Individual professional middle name
Provider Name Suffix Text	JR.
	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	2001
	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	GATEWAY MEDICAL GROUP OF SAN DIEGO
	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	9830086784
	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	4
	Total number of individual professionals affiliated with the Group Practice based on Group Practice PAC ID
Line 1 Street Address	610 EUCLID AVE
	Group Practice or individual's line 1 address
Line 2 Street Address	SUITE 302
	Group Practice or individual's line 2 address
City	NATIONAL CITY
	Group Practice or individual's city
State	CA
	Group Practice or individual's state
Zip Code	919502953
	Group Practice or individual's zip code (9 digits when available)
Phone Number	6195277700
	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	050222
	Medicare CCN of hospital where individual professional provides service 1
Hospital Affiliation LBN 1	SHARP CHULA VISTA MEDICAL CENTER
	Legal business name of hospital where individual professional provides service 1
Professional Accepts Medicare Assignment	Y