Physician Compare National (NPI:1164480166)

HEALTHCARE PROVIDER: SAM STAFFORD III 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	1164480166
	Unique healthcare provider (clinician) ID assigned by NPPES
PECOS UID	2163317140
	Unique individual clinician ID assigned by PECOS
Professional Enrollment ID	I20040223000439
	Unique ID for the individual professional enrollment that is the source for the data in the observation
Provider Last Name	STAFFORD
	Individual professional last name
Provider First Name	SAM
	Individual professional first name
Provider Name Suffix Text	III
	The name suffix of the provider if the provider is an individual. The name suffix is a ''generation-related'' suffix, such as Jr., Sr., II, III, IV, or V.
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	MEDICAL UNIVERSITY OF SOUTH CAROLINA COLLEGE OF MEDICINE
	Individual professional's medical school
Graduation Year	1971
	Individual professional's medical school graduation year
Primary Specialty	DERMATOLOGY
	Primary medical specialty reported by the individual professional in the selected enrollment

Practice Information
Organization Legal Name	MT PLEASANT DERMATOLOGY
	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	6204721285
	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	5
	Total number of individual professionals affiliated with the Group Practice based on Group Practice PAC ID
Line 1 Street Address	570 LONG POINT RD
	Group Practice or individual's line 1 address
Line 2 Street Address	SUITE 200
	Group Practice or individual's line 2 address
City	MOUNT PLEASANT
	Group Practice or individual's city
State	SC
	Group Practice or individual's state
Zip Code	294647940
	Group Practice or individual's zip code (9 digits when available)
Phone Number	8438810320230
	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	420087
	Medicare CCN of hospital where individual professional provides service 1
Hospital Affiliation LBN 1	ROPER HOSPITAL
	Legal business name of hospital where individual professional provides service 1
Professional Accepts Medicare Assignment	Y