Physician Compare National (NPI:1851472989)

HEALTHCARE PROVIDER: JODY A. STARK NP

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

Individual Professional Information
NPI	1851472989
	Unique healthcare provider (clinician) ID assigned by NPPES
PECOS UID	0244123743
	Unique individual clinician ID assigned by PECOS
Professional Enrollment ID	I20040206000952
	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	JODY
	Individual professional first name
Provider Middle Name	A
	Individual professional middle name
Provider Gender	F
	The provider's gender if the provider is a person.
Provider Credential Text	NP
	The abbreviations for professional degrees or credentials used or held by the provider, if the provider is an individual. Examples are MD, DDS, CSW, CNA, AA, NP, RNA, or PSY. These credential designations will not be verified by NPS.

Medical School Information
Medical School Name	OTHER
	Individual professional's medical school
Graduation Year	1994
	Individual professional's medical school graduation year
Primary Specialty	NURSE PRACTITIONER
	Primary medical specialty reported by the individual professional in the selected enrollment

Practice Information
Line 1 Street Address	932 W IDAHO AVE
	Group Practice or individual's line 1 address
Line 2 Street Address	SUITE 100
	Group Practice or individual's line 2 address
City	ONTARIO
	Group Practice or individual's city
State	OR
	Group Practice or individual's state
Zip Code	979142155
	Group Practice or individual's zip code (9 digits when available)

Hospital(s) Affiliation Information
Hospital Affiliation CCN 1	380052
	Medicare CCN of hospital where individual professional provides service 1
Hospital Affiliation LBN 1	SAINT ALPHONSUS MEDICAL CENTER - ONTARIO, INC
	Legal business name of hospital where individual professional provides service 1
Hospital Affiliation CCN 2	130006
	Medicare CCN of hospital where individual professional provides service 2
Hospital Affiliation LBN 2	ST LUKE'S REGIONAL MEDICAL CENTER
	Legal business name of hospital where individual professional provides service 2
Hospital Affiliation CCN 3	130071
	Medicare CCN of hospital where individual professional provides service 3
Hospital Affiliation LBN 3	ST LUKE'S NAMPA MEDICAL CENTER
	Legal business name of hospital where individual professional provides service 3
Hospital Affiliation CCN 4	130014
	Medicare CCN of hospital where individual professional provides service 4
Hospital Affiliation LBN 4	WEST VALLEY MEDICAL CENTER
	Legal business name of hospital where individual professional provides service 4
Hospital Affiliation CCN 5	131307
	Medicare CCN of hospital where individual professional provides service 5
Hospital Affiliation LBN 5	WEISER MEMORIAL HOSPITAL
	Legal business name of hospital where individual professional provides service 5
Professional Accepts Medicare Assignment	Y

Physician Compare National (NPI:1851472989)

HEALTHCARE PROVIDER: JODY A. STARK NP

Individual Professional Information

Medical School Information

Practice Information

Hospital(s) Affiliation Information