Physician Compare National (NPI:1841287208)

HEALTHCARE PROVIDER: JORGE L SERRA 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	1841287208
	Unique healthcare provider (clinician) ID assigned by NPPES
PECOS UID	1658448170
	Unique individual clinician ID assigned by PECOS
Professional Enrollment ID	I20080925000569
	Unique ID for the individual professional enrollment that is the source for the data in the observation
Provider Last Name	SERRA
	Individual professional last name
Provider First Name	JORGE
	Individual professional first name
Provider Middle Name	L
	Individual professional middle name
Provider Gender	M
	The provider's gender if the provider is a person.

Medical School Information
Medical School Name	UNIVERSITY OF PUERTO RICO SCHOOL OF MEDICINE
	Individual professional's medical school
Graduation Year	1986
	Individual professional's medical school graduation year
Primary Specialty	INTERNAL MEDICINE
	Primary medical specialty reported by the individual professional in the selected enrollment

Practice Information
Line 1 Street Address	3501 HEALTH CTR BLVD
	Group Practice or individual's line 1 address
Line 2 Street Address	SUITE 2145
	Group Practice or individual's line 2 address
City	ESTERO
	Group Practice or individual's city
State	FL
	Group Practice or individual's state
Zip Code	341358134
	Group Practice or individual's zip code (9 digits when available)

Hospital(s) Affiliation Information
Hospital Affiliation CCN 1	100012
	Medicare CCN of hospital where individual professional provides service 1
Hospital Affiliation LBN 1	LEE MEMORIAL HOSPITAL
	Legal business name of hospital where individual professional provides service 1
Professional Accepts Medicare Assignment	Y