Physician Compare National (NPI:1104827799)

HEALTHCARE PROVIDER: LISA ELAINE MEDWEDEFF 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	1104827799
	Unique healthcare provider (clinician) ID assigned by NPPES
PECOS UID	1951459338
	Unique individual clinician ID assigned by PECOS
Professional Enrollment ID	I20090423000721
	Unique ID for the individual professional enrollment that is the source for the data in the observation
Provider Last Name	MEDWEDEFF
	Individual professional last name
Provider First Name	LISA
	Individual professional first name
Provider Middle Name	E
	Individual professional middle name
Provider Gender	F
	The provider's gender if the provider is a person.

Medical School Information
Medical School Name	UNIVERSITY OF TEXAS SOUTHWESTERN MEDICAL SCHOOL AT DALLAS
	Individual professional's medical school
Graduation Year	1994
	Individual professional's medical school graduation year
Primary Specialty	INTERNAL MEDICINE
	Primary medical specialty reported by the individual professional in the selected enrollment

Practice Information
Organization Legal Name	LISA MEDWEDEFF MD PA
	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	6204984685
	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	2
	Total number of individual professionals affiliated with the Group Practice based on Group Practice PAC ID
Line 1 Street Address	5425 W SPRING CREEK PKWY
	Group Practice or individual's line 1 address
Line 2 Street Address	SUITE 210
	Group Practice or individual's line 2 address
City	PLANO
	Group Practice or individual's city
State	TX
	Group Practice or individual's state
Zip Code	750244241
	Group Practice or individual's zip code (9 digits when available)
Phone Number	9726083333
	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	450651
	Medicare CCN of hospital where individual professional provides service 1
Hospital Affiliation LBN 1	MEDICAL CITY PLANO
	Legal business name of hospital where individual professional provides service 1
Hospital Affiliation CCN 2	450771
	Medicare CCN of hospital where individual professional provides service 2
Hospital Affiliation LBN 2	TEXAS HEALTH PRESBYTERIAN HOSPITAL PLANO
	Legal business name of hospital where individual professional provides service 2
Professional Accepts Medicare Assignment	Y