Physician Compare National (NPI:1306936638)

HEALTHCARE PROVIDER:

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

Individual Professional Information
NPI	1306936638
	Unique healthcare provider (clinician) ID assigned by NPPES
PECOS UID	6204903297
	Unique individual clinician ID assigned by PECOS
Professional Enrollment ID	I20111115000237
	Unique ID for the individual professional enrollment that is the source for the data in the observation
Provider Last Name	COREY
	Individual professional last name
Provider First Name	STEPHEN
	Individual professional first name
Provider Middle Name	VINCENT
	Individual professional middle name
Provider Name Suffix Text	SR.
	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.

Medical School Information
Medical School Name	TEMPLE UNIVERSITY SCHOOL OF PODIATRIC MEDICINE
	Individual professional's medical school
Graduation Year	1986
	Individual professional's medical school graduation year
Primary Specialty	PODIATRY
	Primary medical specialty reported by the individual professional in the selected enrollment

Practice Information
Line 1 Street Address	402 NELSON BLVD
	Group Practice or individual's line 1 address
Line 2 Street Address	SUITE 300
	Group Practice or individual's line 2 address
City	KINGSTREE
	Group Practice or individual's city
State	SC
	Group Practice or individual's state
Zip Code	295564058
	Group Practice or individual's zip code (9 digits when available)

Hospital(s) Affiliation Information
Hospital Affiliation CCN 1	420109
	Medicare CCN of hospital where individual professional provides service 1
Hospital Affiliation LBN 1	MCLEOD HEALTH CLARENDON
	Legal business name of hospital where individual professional provides service 1
Professional Accepts Medicare Assignment	Y