Physician Compare National (NPI:1992777460)

HEALTHCARE PROVIDER: JOSE MARIO MARINA JR. D.O.

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

Individual Professional Information
NPI	1992777460
	Unique healthcare provider (clinician) ID assigned by NPPES
PECOS UID	2163494402
	Unique individual clinician ID assigned by PECOS
Professional Enrollment ID	I20040813000337
	Unique ID for the individual professional enrollment that is the source for the data in the observation
Provider Last Name	MARINA
	Individual professional last name
Provider First Name	JOSE
	Individual professional first name
Provider Middle Name	M
	Individual professional middle name
Provider Gender	M
	The provider's gender if the provider is a person.
Provider Credential Text	MD
	The abbreviations for professional degrees or credentials used or held by the provider, if the provider is an individual. Examples are MD, DDS, CSW, CNA, AA, NP, RNA, or PSY. These credential designations will not be verified by NPS.

Medical School Information
Medical School Name	NOVA SOUTHEASTERN COLLEGE OF OSTEO MEDICINE
	Individual professional's medical school
Graduation Year	1993
	Individual professional's medical school graduation year
Primary Specialty	ORTHOPEDIC SURGERY
	Primary medical specialty reported by the individual professional in the selected enrollment

Practice Information
Organization Legal Name	RENAISSANCE PROVIDERS
	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	3476877879
	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	15
	Total number of individual professionals affiliated with the Group Practice based on Group Practice PAC ID
Line 1 Street Address	1022 E GRIFFIN PKWY
	Group Practice or individual's line 1 address
Line 2 Street Address	SUITE 108
	Group Practice or individual's line 2 address
City	MISSION
	Group Practice or individual's city
State	TX
	Group Practice or individual's state
Zip Code	785722401
	Group Practice or individual's zip code (9 digits when available)
Phone Number	9565837111
	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	450869
	Medicare CCN of hospital where individual professional provides service 1
Hospital Affiliation LBN 1	DOCTORS HOSPITAL AT RENAISSANCE
	Legal business name of hospital where individual professional provides service 1
Professional Accepts Medicare Assignment	Y