Physician Compare National (NPI:1891888129)

HEALTHCARE PROVIDER:

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

Individual Professional Information
NPI	1891888129
	Unique healthcare provider (clinician) ID assigned by NPPES
PECOS UID	7810035532
	Unique individual clinician ID assigned by PECOS
Professional Enrollment ID	I20091117000241
	Unique ID for the individual professional enrollment that is the source for the data in the observation
Provider Last Name	PRESTON
	Individual professional last name
Provider First Name	JOHN
	Individual professional first name
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	1979
	Individual professional's medical school graduation year
Primary Specialty	PSYCHOLOGIST, CLINICAL
	Primary medical specialty reported by the individual professional in the selected enrollment

Practice Information
Line 1 Street Address	4380 CREEKSIDE DR
	Group Practice or individual's line 1 address
City	SHINGLE SPRINGS
	Group Practice or individual's city
State	CA
	Group Practice or individual's state
Zip Code	956828393
	Group Practice or individual's zip code (9 digits when available)
Phone Number	9165580282
	Phone number is listed only when there is a single phone number available for the practice location address

Hospital(s) Affiliation Information
Professional Accepts Medicare Assignment	Y