Physician Compare National (NPI:1841288172)

HEALTHCARE PROVIDER: MOISES ORTIZ-VILLALOBOS 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	1841288172
	Unique healthcare provider (clinician) ID assigned by NPPES
PECOS UID	8426206186
	Unique individual clinician ID assigned by PECOS
Professional Enrollment ID	I20130403000415
	Unique ID for the individual professional enrollment that is the source for the data in the observation
Provider Last Name	ORTIZ VILLALOBOS
	Individual professional last name
Provider First Name	MOISES
	Individual professional first 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	1989
	Individual professional's medical school graduation year
Primary Specialty	NEPHROLOGY
	Primary medical specialty reported by the individual professional in the selected enrollment
Secondary Specialty 1	INTERNAL MEDICINE
	First secondary medical specialty reported by the individual professional in the selected enrollment
All Secondary Specialties	INTERNAL MEDICINE
	All four secondary specialties reported by the individual professional in the selected enrollment, separated by commas

Practice Information
Organization Legal Name	GRUPO RENAL DEL ESTE, PSC
	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	3274775333
	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	CONSOLIDATED MALL
	Group Practice or individual's line 1 address
Line 2 Street Address	SUITE 307 CALLE GAUTIER BENITEZ
	Group Practice or individual's line 2 address
City	CAGUAS
	Group Practice or individual's city
State	PR
	Group Practice or individual's state
Zip Code	00726
	Group Practice or individual's zip code (9 digits when available)
Phone Number	7877467441
	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	400104
	Medicare CCN of hospital where individual professional provides service 1
Hospital Affiliation LBN 1	HOSPITAL MENONITA CAGUAS INC
	Legal business name of hospital where individual professional provides service 1
Hospital Affiliation CCN 2	400005
	Medicare CCN of hospital where individual professional provides service 2
Hospital Affiliation LBN 2	HIMA SAN PABLO HUMACAO
	Legal business name of hospital where individual professional provides service 2
Hospital Affiliation CCN 3	400120
	Medicare CCN of hospital where individual professional provides service 3
Hospital Affiliation LBN 3	HIMA SAN PABLO-CAGUAS
	Legal business name of hospital where individual professional provides service 3
Professional Accepts Medicare Assignment	Y