Physician Compare National (NPI:1942469408)

HEALTHCARE PROVIDER: JACQUELINE MARIE WEGGE 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	1942469408
	Unique healthcare provider (clinician) ID assigned by NPPES
PECOS UID	2961773379
	Unique individual clinician ID assigned by PECOS
Professional Enrollment ID	I20170803001497
	Unique ID for the individual professional enrollment that is the source for the data in the observation
Provider Last Name	WEGGE
	Individual professional last name
Provider First Name	JACQUELINE
	Individual professional first name
Provider Middle Name	MARIE
	Individual professional middle name
Provider Gender	F
	The provider's gender if the provider is a person.

Medical School Information
Medical School Name	SOUTHERN ILLINOIS UNIVERSITY SCHOOL OF MEDICINE
	Individual professional's medical school
Graduation Year	2008
	Individual professional's medical school graduation year
Primary Specialty	PLASTIC AND RECONSTRUCTIVE SURGERY
	Primary medical specialty reported by the individual professional in the selected enrollment

Practice Information
Organization Legal Name	CLEAR LAKE SPECIALTIES PA
	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	7214962117
	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	58
	Total number of individual professionals affiliated with the Group Practice based on Group Practice PAC ID
Line 1 Street Address	7111 MEDICAL CTR DR
	Group Practice or individual's line 1 address
Line 2 Street Address	SUITE 109
	Group Practice or individual's line 2 address
City	TEXAS CITY
	Group Practice or individual's city
State	TX
	Group Practice or individual's state
Zip Code	775912667
	Group Practice or individual's zip code (9 digits when available)
Phone Number	2817241860
	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	450709
	Medicare CCN of hospital where individual professional provides service 1
Hospital Affiliation LBN 1	HOUSTON METHODIST ST JOHN HOSPITAL
	Legal business name of hospital where individual professional provides service 1
Hospital Affiliation CCN 2	450097
	Medicare CCN of hospital where individual professional provides service 2
Hospital Affiliation LBN 2	BAYSHORE MEDICAL CENTER
	Legal business name of hospital where individual professional provides service 2
Professional Accepts Medicare Assignment	Y