Physician Compare National (NPI:1972624542)

HEALTHCARE PROVIDER: JACK B STEPHENSON IV 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	1972624542
	Unique healthcare provider (clinician) ID assigned by NPPES
PECOS UID	5193943611
	Unique individual clinician ID assigned by PECOS
Professional Enrollment ID	I20140826000332
	Unique ID for the individual professional enrollment that is the source for the data in the observation
Provider Last Name	STEPHENSON
	Individual professional last name
Provider First Name	JACK
	Individual professional first name
Provider Middle Name	B
	Individual professional middle name
Provider Name Suffix Text	IV
	The name suffix of the provider if the provider is an individual. The name suffix is a ''generation-related'' suffix, such as Jr., Sr., II, III, IV, or V.
Provider Gender	M
	The provider's gender if the provider is a person.

Medical School Information
Medical School Name	BAYLOR COLLEGE OF MEDICINE
	Individual professional's medical school
Graduation Year	2007
	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
Secondary Specialty 1	HAND SURGERY
	First secondary medical specialty reported by the individual professional in the selected enrollment
All Secondary Specialties	HAND SURGERY
	All four secondary specialties reported by the individual professional in the selected enrollment, separated by commas

Practice Information
Organization Legal Name	PLASTIC AND HAND SURGEONS OF KATY PLLC
	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	3678872769
	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	23960 KATY FWY
	Group Practice or individual's line 1 address
Line 2 Street Address	SUITE 380
	Group Practice or individual's line 2 address
City	KATY
	Group Practice or individual's city
State	TX
	Group Practice or individual's state
Zip Code	774940893
	Group Practice or individual's zip code (9 digits when available)
Phone Number	8322324263
	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	450847
	Medicare CCN of hospital where individual professional provides service 1
Hospital Affiliation LBN 1	MEMORIAL HERMANN KATY HOSPITAL
	Legal business name of hospital where individual professional provides service 1
Professional Accepts Medicare Assignment	Y