Physician Compare National (NPI:1922270156)

HEALTHCARE PROVIDER: DAVID HUDDLESTON

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

Individual Professional Information
NPI	1922270156
	Unique healthcare provider (clinician) ID assigned by NPPES
PECOS UID	4688816960
	Unique individual clinician ID assigned by PECOS
Professional Enrollment ID	I20190719001763
	Unique ID for the individual professional enrollment that is the source for the data in the observation
Provider Last Name	HUDDLESTON
	Individual professional last name
Provider First Name	DAVID
	Individual professional first name
Provider Middle Name	B
	Individual professional middle name
Provider Gender	M
	The provider's gender if the provider is a person.

Medical School Information
Medical School Name	UNIVERSITY OF TEXAS MEDICAL BRANCH AT GALVESTON
	Individual professional's medical school
Graduation Year	2007
	Individual professional's medical school graduation year
Primary Specialty	GENERAL SURGERY
	Primary medical specialty reported by the individual professional in the selected enrollment

Practice Information
Organization Legal Name	ALI'I HEALTH CENTER
	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	4486984549
	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	30
	Total number of individual professionals affiliated with the Group Practice based on Group Practice PAC ID
Line 1 Street Address	78 -6831 ALII DR
	Group Practice or individual's line 1 address
Line 2 Street Address	SUITE 422
	Group Practice or individual's line 2 address
City	KAILUA KONA
	Group Practice or individual's city
State	HI
	Group Practice or individual's state
Zip Code	967405402
	Group Practice or individual's zip code (9 digits when available)
Phone Number	8087478321
	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	120019
	Medicare CCN of hospital where individual professional provides service 1
Hospital Affiliation LBN 1	KONA COMMUNITY HOSPITAL
	Legal business name of hospital where individual professional provides service 1
Professional Accepts Medicare Assignment	Y