Physician Compare National (NPI:1942289616)

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	1942289616
	Unique healthcare provider (clinician) ID assigned by NPPES
PECOS UID	1759481047
	Unique individual clinician ID assigned by PECOS
Professional Enrollment ID	I20070716000629
	Unique ID for the individual professional enrollment that is the source for the data in the observation
Provider Last Name	VENEGAS
	Individual professional last name
Provider First Name	CARLOS
	Individual professional first name
Provider Middle Name	A
	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	1965
	Individual professional's medical school graduation year
Primary Specialty	GENERAL PRACTICE
	Primary medical specialty reported by the individual professional in the selected enrollment
Secondary Specialty 1	PEDIATRIC MEDICINE
	First secondary medical specialty reported by the individual professional in the selected enrollment
All Secondary Specialties	PEDIATRIC MEDICINE
	All four secondary specialties reported by the individual professional in the selected enrollment, separated by commas

Practice Information
Line 1 Street Address	4225 TWEEDY BLVD
	Group Practice or individual's line 1 address
City	SOUTH GATE
	Group Practice or individual's city
State	CA
	Group Practice or individual's state
Zip Code	902806217
	Group Practice or individual's zip code (9 digits when available)

Hospital(s) Affiliation Information
Professional Accepts Medicare Assignment	Y