Physician Compare National (NPI:1902272339)

HEALTHCARE PROVIDER: ROSS STUART HENDRICKS C.R.N.P.

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

Individual Professional Information
NPI	1902272339
	Unique healthcare provider (clinician) ID assigned by NPPES
PECOS UID	8426367194
	Unique individual clinician ID assigned by PECOS
Professional Enrollment ID	I20151020000989
	Unique ID for the individual professional enrollment that is the source for the data in the observation
Provider Last Name	HENDRICKS
	Individual professional last name
Provider First Name	ROSS
	Individual professional first name
Provider Middle Name	S
	Individual professional middle 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	2014
	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
Organization Legal Name	PURE DERMATOLOGY AND AESTHETICS, PC
	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	5092966747
	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	2
	Total number of individual professionals affiliated with the Group Practice based on Group Practice PAC ID
Line 1 Street Address	5346 STADIUM TRACE PKWY
	Group Practice or individual's line 1 address
Line 2 Street Address	SUITE 100
	Group Practice or individual's line 2 address
City	HOOVER
	Group Practice or individual's city
State	AL
	Group Practice or individual's state
Zip Code	352444583
	Group Practice or individual's zip code (9 digits when available)
Phone Number	2056828022
	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	010104
	Medicare CCN of hospital where individual professional provides service 1
Hospital Affiliation LBN 1	GRANDVIEW MEDICAL CENTER
	Legal business name of hospital where individual professional provides service 1
Professional Accepts Medicare Assignment	Y