Physician Compare National (NPI:1124055058)

HEALTHCARE PROVIDER: LISA SPACEK 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	1124055058
	Unique healthcare provider (clinician) ID assigned by NPPES
PECOS UID	4880631076
	Unique individual clinician ID assigned by PECOS
Professional Enrollment ID	I20141014000749
	Unique ID for the individual professional enrollment that is the source for the data in the observation
Provider Last Name	SPACEK
	Individual professional last name
Provider First Name	LISA
	Individual professional first name
Provider Middle Name	A
	Individual professional middle name
Provider Gender	F
	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	OHIO STATE UNIVERSITY COLLEGE OF MEDICINE
	Individual professional's medical school
Graduation Year	1997
	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	INFECTIOUS DISEASE
	First secondary medical specialty reported by the individual professional in the selected enrollment
All Secondary Specialties	INFECTIOUS DISEASE
	All four secondary specialties reported by the individual professional in the selected enrollment, separated by commas

Practice Information
Organization Legal Name	JEFFERSON UNIVERSITY PHYSICIANS
	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	7911819180
	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	1152
	Total number of individual professionals affiliated with the Group Practice based on Group Practice PAC ID
Line 1 Street Address	1015 CHESTNUT ST
	Group Practice or individual's line 1 address
Line 2 Street Address	SUITE 1020
	Group Practice or individual's line 2 address
City	PHILADELPHIA
	Group Practice or individual's city
State	PA
	Group Practice or individual's state
Zip Code	191074310
	Group Practice or individual's zip code (9 digits when available)
Phone Number	2159554730
	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	390174
	Medicare CCN of hospital where individual professional provides service 1
Hospital Affiliation LBN 1	THOMAS JEFFERSON UNIVERSITY HOSPITAL
	Legal business name of hospital where individual professional provides service 1
Professional Accepts Medicare Assignment	Y