Physician Compare National (NPI:1891992434)

HEALTHCARE PROVIDER: DIEGO VELASCO 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	1891992434
	Unique healthcare provider (clinician) ID assigned by NPPES
PECOS UID	9739275082
	Unique individual clinician ID assigned by PECOS
Professional Enrollment ID	I20071017000743
	Unique ID for the individual professional enrollment that is the source for the data in the observation
Provider Last Name	VELASCO
	Individual professional last name
Provider First Name	DIEGO
	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	1968
	Individual professional's medical school graduation year
Primary Specialty	EMERGENCY MEDICINE
	Primary medical specialty reported by the individual professional in the selected enrollment
Secondary Specialty 1	GENERAL SURGERY
	First secondary medical specialty reported by the individual professional in the selected enrollment
All Secondary Specialties	GENERAL SURGERY
	All four secondary specialties reported by the individual professional in the selected enrollment, separated by commas

Practice Information
Organization Legal Name	BOA VIDA HOSPITAL OF ABERDEEN MS LLC
	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	0244505840
	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	29
	Total number of individual professionals affiliated with the Group Practice based on Group Practice PAC ID
Line 1 Street Address	400 S CHESTNUT ST
	Group Practice or individual's line 1 address
City	ABERDEEN
	Group Practice or individual's city
State	MS
	Group Practice or individual's state
Zip Code	397303335
	Group Practice or individual's zip code (9 digits when available)
Phone Number	6623692455
	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	251302
	Medicare CCN of hospital where individual professional provides service 1
Hospital Affiliation LBN 1	MONROE REGIONAL HOSPITAL
	Legal business name of hospital where individual professional provides service 1
Professional Accepts Medicare Assignment	Y