Physician Compare National (NPI:1962639757)

HEALTHCARE PROVIDER: MANUEL CORREA FORTES M.D.

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

Individual Professional Information
NPI	1962639757
	Unique healthcare provider (clinician) ID assigned by NPPES
PECOS UID	8123269487
	Unique individual clinician ID assigned by PECOS
Professional Enrollment ID	I20191209000125
	Unique ID for the individual professional enrollment that is the source for the data in the observation
Provider Last Name	FORTES
	Individual professional last name
Provider First Name	MANUEL
	Individual professional first 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	2004
	Individual professional's medical school graduation year
Primary Specialty	INTERVENTIONAL RADIOLOGY
	Primary medical specialty reported by the individual professional in the selected enrollment

Practice Information
Organization Legal Name	FAIRFAX RADIOLOGICAL CONSULTANTS PC
	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	8628970324
	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	85
	Total number of individual professionals affiliated with the Group Practice based on Group Practice PAC ID
Line 1 Street Address	8318 ARLINGTON BLVD
	Group Practice or individual's line 1 address
Line 2 Street Address	SUITE 200
	Group Practice or individual's line 2 address
City	FAIRFAX
	Group Practice or individual's city
State	VA
	Group Practice or individual's state
Zip Code	220315218
	Group Practice or individual's zip code (9 digits when available)
Phone Number	7036984455
	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	370028
	Medicare CCN of hospital where individual professional provides service 1
Hospital Affiliation LBN 1	INTEGRIS BAPTIST MEDICAL CENTER, INC
	Legal business name of hospital where individual professional provides service 1
Hospital Affiliation CCN 2	370211
	Medicare CCN of hospital where individual professional provides service 2
Hospital Affiliation LBN 2	INTEGRIS CANADIAN VALLEY HOSPITAL
	Legal business name of hospital where individual professional provides service 2
Hospital Affiliation CCN 3	370236
	Medicare CCN of hospital where individual professional provides service 3
Hospital Affiliation LBN 3	INTEGRIS HEALTH EDMOND
	Legal business name of hospital where individual professional provides service 3
Hospital Affiliation CCN 4	490063
	Medicare CCN of hospital where individual professional provides service 4
Hospital Affiliation LBN 4	INOVA FAIRFAX HOSPITAL
	Legal business name of hospital where individual professional provides service 4
Professional Accepts Medicare Assignment	Y