Physician Compare National (NPI:1902838857)

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	1902838857
	Unique healthcare provider (clinician) ID assigned by NPPES
PECOS UID	9638202344
	Unique individual clinician ID assigned by PECOS
Professional Enrollment ID	I20100803000091
	Unique ID for the individual professional enrollment that is the source for the data in the observation
Provider Last Name	JIMENEZ
	Individual professional last name
Provider First Name	CARLOS
	Individual professional first name
Provider Middle Name	C
	Individual professional middle 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	1964
	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	41 15TH ST
	Group Practice or individual's line 1 address
City	WHEELING
	Group Practice or individual's city
State	WV
	Group Practice or individual's state
Zip Code	260033549
	Group Practice or individual's zip code (9 digits when available)

Hospital(s) Affiliation Information
Hospital Affiliation CCN 1	510050
	Medicare CCN of hospital where individual professional provides service 1
Hospital Affiliation LBN 1	WHEELING HOSPITAL
	Legal business name of hospital where individual professional provides service 1
Hospital Affiliation CCN 2	510013
	Medicare CCN of hospital where individual professional provides service 2
Hospital Affiliation LBN 2	REYNOLDS MEMORIAL HOSPITAL
	Legal business name of hospital where individual professional provides service 2
Hospital Affiliation CCN 3	360211
	Medicare CCN of hospital where individual professional provides service 3
Hospital Affiliation LBN 3	TRINITY MEDICAL CTR EAST &TRINITY MEDICAL CTR WEST
	Legal business name of hospital where individual professional provides service 3
Professional Accepts Medicare Assignment	Y