Physician Compare National (NPI:1922268697)

HEALTHCARE PROVIDER: SEBASTIAN KLISIEWICZ D.O.

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

Individual Professional Information
NPI	1922268697
	Unique healthcare provider (clinician) ID assigned by NPPES
PECOS UID	3779730262
	Unique individual clinician ID assigned by PECOS
Professional Enrollment ID	I20140916002411
	Unique ID for the individual professional enrollment that is the source for the data in the observation
Provider Last Name	KLISIEWICZ
	Individual professional last name
Provider First Name	SEBASTIAN
	Individual professional first name
Provider Gender	M
	The provider's gender if the provider is a person.

Medical School Information
Medical School Name	MIDWESTERN UNIVERSITY, CHICAGO COLLEGE OF OSTEOPATHIC MED
	Individual professional's medical school
Graduation Year	2008
	Individual professional's medical school graduation year
Primary Specialty	PHYSICAL MEDICINE AND REHABILITATION
	Primary medical specialty reported by the individual professional in the selected enrollment

Practice Information
Organization Legal Name	INTEGRATIVE REHAB MEDICINE INC
	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	5698003135
	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	2
	Total number of individual professionals affiliated with the Group Practice based on Group Practice PAC ID
Line 1 Street Address	9250 CORKSCREW RD
	Group Practice or individual's line 1 address
Line 2 Street Address	SUITE 15
	Group Practice or individual's line 2 address
City	ESTERO
	Group Practice or individual's city
State	FL
	Group Practice or individual's state
Zip Code	339283217
	Group Practice or individual's zip code (9 digits when available)
Phone Number	2396873199
	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	100012
	Medicare CCN of hospital where individual professional provides service 1
Hospital Affiliation LBN 1	LEE MEMORIAL HOSPITAL
	Legal business name of hospital where individual professional provides service 1
Hospital Affiliation CCN 2	100244
	Medicare CCN of hospital where individual professional provides service 2
Hospital Affiliation LBN 2	CAPE CORAL HOSPITAL - 100244
	Legal business name of hospital where individual professional provides service 2
Professional Accepts Medicare Assignment	Y