Physician Compare National (NPI:1992813224)

HEALTHCARE PROVIDER: JOHN MODICA 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	1992813224
	Unique healthcare provider (clinician) ID assigned by NPPES
PECOS UID	1355335852
	Unique individual clinician ID assigned by PECOS
Professional Enrollment ID	I20120508000435
	Unique ID for the individual professional enrollment that is the source for the data in the observation
Provider Last Name	MODICA
	Individual professional last name
Provider First Name	JOHN
	Individual professional first 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	OTHER
	Individual professional's medical school
Graduation Year	1983
	Individual professional's medical school graduation year
Primary Specialty	CARDIOVASCULAR DISEASE (CARDIOLOGY)
	Primary medical specialty reported by the individual professional in the selected enrollment
Secondary Specialty 1	CRITICAL CARE (INTENSIVISTS)
	First secondary medical specialty reported by the individual professional in the selected enrollment
All Secondary Specialties	CRITICAL CARE (INTENSIVISTS)
	All four secondary specialties reported by the individual professional in the selected enrollment, separated by commas

Practice Information
Line 1 Street Address	114 WOODLAND ST
	Group Practice or individual's line 1 address
City	HARTFORD
	Group Practice or individual's city
State	CT
	Group Practice or individual's state
Zip Code	061051208
	Group Practice or individual's zip code (9 digits when available)
Phone Number	8609163402
	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	070003
	Medicare CCN of hospital where individual professional provides service 1
Hospital Affiliation LBN 1	DAY KIMBALL HOSPITAL
	Legal business name of hospital where individual professional provides service 1
Professional Accepts Medicare Assignment	Y