Physician Compare National (NPI:1902002439)

HEALTHCARE PROVIDER: MONICA PRISCILLA WENTWORTH M.D

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

Individual Professional Information
NPI	1902002439
	Unique healthcare provider (clinician) ID assigned by NPPES
PECOS UID	6406166750
	Unique individual clinician ID assigned by PECOS
Professional Enrollment ID	I20180110000173
	Unique ID for the individual professional enrollment that is the source for the data in the observation
Provider Last Name	WENTWORTH
	Individual professional last name
Provider First Name	MONICA
	Individual professional first name
Provider Middle Name	PRISCILLA
	Individual professional middle name
Provider Gender	F
	The provider's gender if the provider is a person.

Medical School Information
Medical School Name	OTHER
	Individual professional's medical school
Graduation Year	2007
	Individual professional's medical school graduation year
Primary Specialty	PLASTIC AND RECONSTRUCTIVE SURGERY
	Primary medical specialty reported by the individual professional in the selected enrollment

Practice Information
Line 1 Street Address	512 VICTORIA LN
	Group Practice or individual's line 1 address
Line 2 Street Address	SUITE 1
	Group Practice or individual's line 2 address
City	HARLINGEN
	Group Practice or individual's city
State	TX
	Group Practice or individual's state
Zip Code	785503227
	Group Practice or individual's zip code (9 digits when available)

Hospital(s) Affiliation Information
Hospital Affiliation CCN 1	450033
	Medicare CCN of hospital where individual professional provides service 1
Hospital Affiliation LBN 1	VALLEY BAPTIST MEDICAL CENTER - HARLINGEN
	Legal business name of hospital where individual professional provides service 1
Professional Accepts Medicare Assignment	Y