Physician Compare National (NPI:1932171337)

HEALTHCARE PROVIDER: IRENA MARIA PACANOWSKA-ASSEFA 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	1932171337
	Unique healthcare provider (clinician) ID assigned by NPPES
PECOS UID	1456545219
	Unique individual clinician ID assigned by PECOS
Professional Enrollment ID	I20101105000275
	Unique ID for the individual professional enrollment that is the source for the data in the observation
Provider Last Name	PACANOWSKA-ASSEFA
	Individual professional last name
Provider First Name	IRENA
	Individual professional first name
Provider Middle Name	MARIA
	Individual professional middle name
Provider Gender	F
	The provider's gender if the provider is a person.

Medical School Information
Medical School Name	UNIVERSITY OF MINNESOTA MEDICAL SCHOOL
	Individual professional's medical school
Graduation Year	1984
	Individual professional's medical school graduation year
Primary Specialty	FAMILY MEDICINE
	Primary medical specialty reported by the individual professional in the selected enrollment

Practice Information
Line 1 Street Address	6100 SAINT JOHNS AVE
	Group Practice or individual's line 1 address
Line 2 Street Address	SUITE 4
	Group Practice or individual's line 2 address
City	PALATKA
	Group Practice or individual's city
State	FL
	Group Practice or individual's state
Zip Code	321776859
	Group Practice or individual's zip code (9 digits when available)

Hospital(s) Affiliation Information
Hospital Affiliation CCN 1	100232
	Medicare CCN of hospital where individual professional provides service 1
Hospital Affiliation LBN 1	PUTNAM COMMUNITY MEDICAL CENTER
	Legal business name of hospital where individual professional provides service 1
Professional Accepts Medicare Assignment	Y