Physician Compare National (NPI:1831109743)

HEALTHCARE PROVIDER: CLEMENTE V. ZULUETA JR. 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	1831109743
	Unique healthcare provider (clinician) ID assigned by NPPES
PECOS UID	7719872308
	Unique individual clinician ID assigned by PECOS
Professional Enrollment ID	I20040223000054
	Unique ID for the individual professional enrollment that is the source for the data in the observation
Provider Last Name	ZULUETA
	Individual professional last name
Provider First Name	CLEMENTE
	Individual professional first name
Provider Middle Name	V
	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.
Provider Credential Text	MD
	The abbreviations for professional degrees or credentials used or held by the provider, if the provider is an individual. Examples are MD, DDS, CSW, CNA, AA, NP, RNA, or PSY. These credential designations will not be verified by NPS.

Medical School Information
Medical School Name	OTHER
	Individual professional's medical school
Graduation Year	1992
	Individual professional's medical school graduation year
Primary Specialty	INTERNAL MEDICINE
	Primary medical specialty reported by the individual professional in the selected enrollment
Secondary Specialty 1	ENDOCRINOLOGY
	First secondary medical specialty reported by the individual professional in the selected enrollment
All Secondary Specialties	ENDOCRINOLOGY
	All four secondary specialties reported by the individual professional in the selected enrollment, separated by commas

Practice Information
Line 1 Street Address	726 HWY 15 N
	Group Practice or individual's line 1 address
Line 2 Street Address	SUITE 5
	Group Practice or individual's line 2 address
City	JACKSON
	Group Practice or individual's city
State	KY
	Group Practice or individual's state
Zip Code	413398601
	Group Practice or individual's zip code (9 digits when available)

Hospital(s) Affiliation Information
Hospital Affiliation CCN 1	180139
	Medicare CCN of hospital where individual professional provides service 1
Hospital Affiliation LBN 1	KENTUCKY RIVER MEDICAL CENTER
	Legal business name of hospital where individual professional provides service 1
Hospital Affiliation CCN 2	180103
	Medicare CCN of hospital where individual professional provides service 2
Hospital Affiliation LBN 2	BAPTIST HEALTH LEXINGTON
	Legal business name of hospital where individual professional provides service 2
Professional Accepts Medicare Assignment	Y