Physician Compare National (NPI:1982606539)

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	1982606539
	Unique healthcare provider (clinician) ID assigned by NPPES
PECOS UID	7618045139
	Unique individual clinician ID assigned by PECOS
Professional Enrollment ID	I20081009000687
	Unique ID for the individual professional enrollment that is the source for the data in the observation
Provider Last Name	VALENCIA
	Individual professional last name
Provider First Name	WARREN
	Individual professional first name
Provider Gender	M
	The provider's gender if the provider is a person.

Medical School Information
Medical School Name	STATE UNIVERSITY OF NEW YORK AT BUFFALO SCHOOL OF MEDICINE
	Individual professional's medical school
Graduation Year	1973
	Individual professional's medical school graduation year
Primary Specialty	INTERNAL MEDICINE
	Primary medical specialty reported by the individual professional in the selected enrollment
Secondary Specialty 1	FAMILY MEDICINE
	First secondary medical specialty reported by the individual professional in the selected enrollment
All Secondary Specialties	FAMILY MEDICINE
	All four secondary specialties reported by the individual professional in the selected enrollment, separated by commas

Practice Information
Line 1 Street Address	2030 MOUNTAIN VIEW AVE
	Group Practice or individual's line 1 address
Line 2 Street Address	SUITE 220
	Group Practice or individual's line 2 address
City	LONGMONT
	Group Practice or individual's city
State	CO
	Group Practice or individual's state
Zip Code	805013180
	Group Practice or individual's zip code (9 digits when available)

Hospital(s) Affiliation Information
Hospital Affiliation CCN 1	060003
	Medicare CCN of hospital where individual professional provides service 1
Hospital Affiliation LBN 1	LONGMONT UNITED HOSPITAL
	Legal business name of hospital where individual professional provides service 1
Hospital Affiliation CCN 2	060030
	Medicare CCN of hospital where individual professional provides service 2
Hospital Affiliation LBN 2	MCKEE MEDICAL CENTER
	Legal business name of hospital where individual professional provides service 2
Professional Accepts Medicare Assignment	Y