Physician Compare National (NPI:1912169459)

HEALTHCARE PROVIDER: VINNIE D KALLUMADANDA 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	1912169459
	Unique healthcare provider (clinician) ID assigned by NPPES
PECOS UID	2860547015
	Unique individual clinician ID assigned by PECOS
Professional Enrollment ID	I20090911000401
	Unique ID for the individual professional enrollment that is the source for the data in the observation
Provider Last Name	KALLUMADANDA
	Individual professional last name
Provider First Name	VINNIE
	Individual professional first name
Provider Middle Name	D
	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	2002
	Individual professional's medical school graduation year
Primary Specialty	FAMILY MEDICINE
	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
Line 1 Street Address	901 E ESPERANZA AVE
	Group Practice or individual's line 1 address
Line 2 Street Address	STM PRIMARY CARE CLINIC
	Group Practice or individual's line 2 address
City	MCALLEN
	Group Practice or individual's city
State	TX
	Group Practice or individual's state
Zip Code	785011424
	Group Practice or individual's zip code (9 digits when available)

Hospital(s) Affiliation Information
Hospital Affiliation CCN 1	450869
	Medicare CCN of hospital where individual professional provides service 1
Hospital Affiliation LBN 1	DOCTORS HOSPITAL AT RENAISSANCE
	Legal business name of hospital where individual professional provides service 1
Hospital Affiliation CCN 2	450711
	Medicare CCN of hospital where individual professional provides service 2
Hospital Affiliation LBN 2	RIO GRANDE REGIONAL HOSPITAL
	Legal business name of hospital where individual professional provides service 2
Professional Accepts Medicare Assignment	Y