Physician Compare National (NPI:1104977560)

HEALTHCARE PROVIDER: STEPHEN K OTEY 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	1104977560
	Unique healthcare provider (clinician) ID assigned by NPPES
PECOS UID	0042311417
	Unique individual clinician ID assigned by PECOS
Professional Enrollment ID	I20070730000275
	Unique ID for the individual professional enrollment that is the source for the data in the observation
Provider Last Name	OTEY
	Individual professional last name
Provider First Name	STEPHEN
	Individual professional first name
Provider Middle Name	K
	Individual professional middle name
Provider Gender	M
	The provider's gender if the provider is a person.

Medical School Information
Medical School Name	EAST TENNESSEE STATE UNIVERSITY QUILLEN COLLEGE OF MEDICINE
	Individual professional's medical school
Graduation Year	1992
	Individual professional's medical school graduation year
Primary Specialty	OBSTETRICS/GYNECOLOGY
	Primary medical specialty reported by the individual professional in the selected enrollment

Practice Information
Organization Legal Name	P AND S CLINIC OB-GYN PLLC
	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	5890896252
	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	12
	Total number of individual professionals affiliated with the Group Practice based on Group Practice PAC ID
Line 1 Street Address	255 BAPTIST BLVD
	Group Practice or individual's line 1 address
Line 2 Street Address	SUITE 405
	Group Practice or individual's line 2 address
City	COLUMBUS
	Group Practice or individual's city
State	MS
	Group Practice or individual's state
Zip Code	397052004
	Group Practice or individual's zip code (9 digits when available)
Phone Number	6622569331
	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	250025
	Medicare CCN of hospital where individual professional provides service 1
Hospital Affiliation LBN 1	GILMORE MEMORIAL HOSPITAL
	Legal business name of hospital where individual professional provides service 1
Hospital Affiliation CCN 2	250100
	Medicare CCN of hospital where individual professional provides service 2
Hospital Affiliation LBN 2	BAPTIST MEM HOSP/ GOLDEN TRIANGLE INC
	Legal business name of hospital where individual professional provides service 2
Hospital Affiliation CCN 3	250004
	Medicare CCN of hospital where individual professional provides service 3
Hospital Affiliation LBN 3	NORTH MISSISSIPPI MEDICAL CENTER
	Legal business name of hospital where individual professional provides service 3
Professional Accepts Medicare Assignment	Y