Physician Compare National (NPI:1588640015)

HEALTHCARE PROVIDER: TEDDY WALLACE BROWN JR. 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	1588640015
	Unique healthcare provider (clinician) ID assigned by NPPES
PECOS UID	0244367316
	Unique individual clinician ID assigned by PECOS
Professional Enrollment ID	I20101115000982
	Unique ID for the individual professional enrollment that is the source for the data in the observation
Provider Last Name	BROWN
	Individual professional last name
Provider First Name	TEDDY
	Individual professional first name
Provider Middle Name	W
	Individual professional middle name
Provider Name Suffix Text	JR.
	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	OTHER
	Individual professional's medical school
Graduation Year	1984
	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	MAXILLOFACIAL SURGERY
	First secondary medical specialty reported by the individual professional in the selected enrollment
All Secondary Specialties	MAXILLOFACIAL SURGERY
	All four secondary specialties reported by the individual professional in the selected enrollment, separated by commas

Practice Information
Organization Legal Name	TAMPA BAY SURGICAL GROUP LLP
	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	8224113527
	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	22
	Total number of individual professionals affiliated with the Group Practice based on Group Practice PAC ID
Line 1 Street Address	13910 FIVAY RD
	Group Practice or individual's line 1 address
Line 2 Street Address	SUITE 12
	Group Practice or individual's line 2 address
City	HUDSON
	Group Practice or individual's city
State	FL
	Group Practice or individual's state
Zip Code	346677130
	Group Practice or individual's zip code (9 digits when available)
Phone Number	7278610678
	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	100256
	Medicare CCN of hospital where individual professional provides service 1
Hospital Affiliation LBN 1	REGIONAL MEDICAL CENTER BAYONET POINT
	Legal business name of hospital where individual professional provides service 1
Hospital Affiliation CCN 2	100071
	Medicare CCN of hospital where individual professional provides service 2
Hospital Affiliation LBN 2	BAYFRONT HEALTH BROOKSVILLE
	Legal business name of hospital where individual professional provides service 2
Hospital Affiliation CCN 3	100191
	Medicare CCN of hospital where individual professional provides service 3
Hospital Affiliation LBN 3	MEDICAL CENTER OF TRINITY
	Legal business name of hospital where individual professional provides service 3
Professional Accepts Medicare Assignment	Y