Physician Compare National (NPI:1144570508)

HEALTHCARE PROVIDER: STEFANIE B AVERY FNP-C

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

Individual Professional Information
NPI	1144570508
	Unique healthcare provider (clinician) ID assigned by NPPES
PECOS UID	5395997068
	Unique individual clinician ID assigned by PECOS
Professional Enrollment ID	I20121203000228
	Unique ID for the individual professional enrollment that is the source for the data in the observation
Provider Last Name	AVERY
	Individual professional last name
Provider First Name	STEFANIE
	Individual professional first name
Provider Gender	F
	The provider's gender if the provider is a person.

Medical School Information
Medical School Name	OTHER
	Individual professional's medical school
Graduation Year	2012
	Individual professional's medical school graduation year
Primary Specialty	NURSE PRACTITIONER
	Primary medical specialty reported by the individual professional in the selected enrollment

Practice Information
Organization Legal Name	PROVIDENCE HEALTH AND SERVICES OREGON
	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	0648183608
	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	1094
	Total number of individual professionals affiliated with the Group Practice based on Group Practice PAC ID
Line 1 Street Address	10670 NE CORNELL RD
	Group Practice or individual's line 1 address
Marker of address line 2 suppression	Y
	Marker that address as reported may be incomplete
City	HILLSBORO
	Group Practice or individual's city
State	OR
	Group Practice or individual's state
Zip Code	971249221
	Group Practice or individual's zip code (9 digits when available)

Hospital(s) Affiliation Information
Hospital Affiliation CCN 1	380017
	Medicare CCN of hospital where individual professional provides service 1
Hospital Affiliation LBN 1	LEGACY GOOD SAMARITAN MEDICAL CENTER
	Legal business name of hospital where individual professional provides service 1
Hospital Affiliation CCN 2	380089
	Medicare CCN of hospital where individual professional provides service 2
Hospital Affiliation LBN 2	LEGACY MERIDIAN PARK MEDICAL CENTER
	Legal business name of hospital where individual professional provides service 2
Professional Accepts Medicare Assignment	Y