Physician Compare National (NPI:1437114790)

HEALTHCARE PROVIDER: JON G STAFFEL 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	1437114790
	Unique healthcare provider (clinician) ID assigned by NPPES
PECOS UID	9739363565
	Unique individual clinician ID assigned by PECOS
Professional Enrollment ID	I20110401000819
	Unique ID for the individual professional enrollment that is the source for the data in the observation
Provider Last Name	STAFFEL
	Individual professional last name
Provider First Name	JON
	Individual professional first name
Provider Gender	M
	The provider's gender if the provider is a person.

Medical School Information
Medical School Name	TEXAS TECH UNIVERSITY HEALTH SCIENCE CENTER SCHOOL OF MEDICINE
	Individual professional's medical school
Graduation Year	1981
	Individual professional's medical school graduation year
Primary Specialty	OTOLARYNGOLOGY
	Primary medical specialty reported by the individual professional in the selected enrollment
Secondary Specialty 1	PLASTIC AND RECONSTRUCTIVE SURGERY
	First secondary medical specialty reported by the individual professional in the selected enrollment
All Secondary Specialties	PLASTIC AND RECONSTRUCTIVE SURGERY
	All four secondary specialties reported by the individual professional in the selected enrollment, separated by commas

Practice Information
Organization Legal Name	SHEA CLINIC
	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	3971525635
	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	6133 POPLAR PIKE
	Group Practice or individual's line 1 address
City	MEMPHIS
	Group Practice or individual's city
State	TN
	Group Practice or individual's state
Zip Code	381194707
	Group Practice or individual's zip code (9 digits when available)
Phone Number	9017619720
	Phone number is listed only when there is a single phone number available for the practice location address

Hospital(s) Affiliation Information
Professional Accepts Medicare Assignment	Y