Physician Compare National (NPI:1376669572)

HEALTHCARE PROVIDER: ERIK SCOTT STARK 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	1376669572
	Unique healthcare provider (clinician) ID assigned by NPPES
PECOS UID	1153420906
	Unique individual clinician ID assigned by PECOS
Professional Enrollment ID	I20070620000389
	Unique ID for the individual professional enrollment that is the source for the data in the observation
Provider Last Name	STARK
	Individual professional last name
Provider First Name	ERIK
	Individual professional first name
Provider Middle Name	SCOTT
	Individual professional middle name
Provider Gender	M
	The provider's gender if the provider is a person.

Medical School Information
Medical School Name	STATE UNIVERSITY OF NY UPSTATE MEDICAL UNIVERSITY
	Individual professional's medical school
Graduation Year	2001
	Individual professional's medical school graduation year
Primary Specialty	ORTHOPEDIC SURGERY
	Primary medical specialty reported by the individual professional in the selected enrollment

Practice Information
Organization Legal Name	TRI-CITY ORTHOPAEDIC SURGERY MEDICAL GROUP INC.
	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	1153388434
	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	29
	Total number of individual professionals affiliated with the Group Practice based on Group Practice PAC ID
Line 1 Street Address	6121 PASEO DEL NORTE
	Group Practice or individual's line 1 address
Line 2 Street Address	SUITE 200
	Group Practice or individual's line 2 address
City	CARLSBAD
	Group Practice or individual's city
State	CA
	Group Practice or individual's state
Zip Code	920111161
	Group Practice or individual's zip code (9 digits when available)
Phone Number	7607249000
	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	050128
	Medicare CCN of hospital where individual professional provides service 1
Hospital Affiliation LBN 1	TRI-CITY MEDICAL CENTER
	Legal business name of hospital where individual professional provides service 1
Professional Accepts Medicare Assignment	Y