Physician Compare National (NPI:1861929630)

HEALTHCARE PROVIDER: HEATHER MARIE STIDD PA-C

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

Individual Professional Information
NPI	1861929630
	Unique healthcare provider (clinician) ID assigned by NPPES
PECOS UID	2365714565
	Unique individual clinician ID assigned by PECOS
Professional Enrollment ID	I20170823002137
	Unique ID for the individual professional enrollment that is the source for the data in the observation
Provider Last Name	STIDD
	Individual professional last name
Provider First Name	HEATHER
	Individual professional first name
Provider Middle Name	M
	Individual professional middle name
Provider Gender	F
	The provider's gender if the provider is a person.

Medical School Information
Medical School Name	OTHER
	Individual professional's medical school
Graduation Year	2016
	Individual professional's medical school graduation year
Primary Specialty	PHYSICIAN ASSISTANT
	Primary medical specialty reported by the individual professional in the selected enrollment

Practice Information
Organization Legal Name	ST VINCENT PHYSICIAN SERVICES HOSPITAL AND HEALTH CARE CENTER
	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	9638072184
	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	200
	Total number of individual professionals affiliated with the Group Practice based on Group Practice PAC ID
Line 1 Street Address	8240 NAAB RD
	Group Practice or individual's line 1 address
Marker of address line 2 suppression	Y
	Marker that address as reported may be incomplete
City	INDIANAPOLIS
	Group Practice or individual's city
State	IN
	Group Practice or individual's state
Zip Code	462601985
	Group Practice or individual's zip code (9 digits when available)

Hospital(s) Affiliation Information
Professional Accepts Medicare Assignment	Y