Physician Compare National (NPI:1629212972)

HEALTHCARE PROVIDER: STEPHEN WARD ETHEREDGE M.D.

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

Individual Professional Information
NPI	1629212972
	Unique healthcare provider (clinician) ID assigned by NPPES
PECOS UID	6204086929
	Unique individual clinician ID assigned by PECOS
Professional Enrollment ID	I20121029000507
	Unique ID for the individual professional enrollment that is the source for the data in the observation
Provider Last Name	ETHEREDGE
	Individual professional last name
Provider First Name	STEPHEN
	Individual professional first name
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	2009
	Individual professional's medical school graduation year
Primary Specialty	SPORTS MEDICINE
	Primary medical specialty reported by the individual professional in the selected enrollment
Secondary Specialty 1	FAMILY MEDICINE
	First secondary medical specialty reported by the individual professional in the selected enrollment
All Secondary Specialties	FAMILY MEDICINE
	All four secondary specialties reported by the individual professional in the selected enrollment, separated by commas

Practice Information
Organization Legal Name	BATON ROUGE ORTHOPAEDIC CLNIC, LLC
	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	3274446414
	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	102
	Total number of individual professionals affiliated with the Group Practice based on Group Practice PAC ID
Line 1 Street Address	8080 BLUEBONNET BLVD
	Group Practice or individual's line 1 address
Line 2 Street Address	SUITE 1000
	Group Practice or individual's line 2 address
City	BATON ROUGE
	Group Practice or individual's city
State	LA
	Group Practice or individual's state
Zip Code	708107827
	Group Practice or individual's zip code (9 digits when available)
Phone Number	2259242424
	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	190167
	Medicare CCN of hospital where individual professional provides service 1
Hospital Affiliation LBN 1	MERCY REGIONAL MEDICAL CENTER
	Legal business name of hospital where individual professional provides service 1
Hospital Affiliation CCN 2	190251
	Medicare CCN of hospital where individual professional provides service 2
Hospital Affiliation LBN 2	SURGICAL SPECIALTY CENTER OF BATON ROUGE
	Legal business name of hospital where individual professional provides service 2
Hospital Affiliation CCN 3	190064
	Medicare CCN of hospital where individual professional provides service 3
Hospital Affiliation LBN 3	OUR LADY OF THE LAKE REGIONAL MEDICAL CENTER
	Legal business name of hospital where individual professional provides service 3
Hospital Affiliation CCN 4	190318
	Medicare CCN of hospital where individual professional provides service 4
Professional Accepts Medicare Assignment	Y