Physician Compare National (NPI:1053593079)

HEALTHCARE PROVIDER: TAMIKA BLACKBURN 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	1053593079
	Unique healthcare provider (clinician) ID assigned by NPPES
PECOS UID	8123184751
	Unique individual clinician ID assigned by PECOS
Professional Enrollment ID	I20141021000070
	Unique ID for the individual professional enrollment that is the source for the data in the observation
Provider Last Name	BLACKBURN
	Individual professional last name
Provider First Name	TAMIKA
	Individual professional first name
Provider Middle Name	L
	Individual professional middle name
Provider Gender	F
	The provider's gender if the provider is a person.

Medical School Information
Medical School Name	NEW YORK UNIVERSITY MEDICAL COLLEGE - NLG
	Individual professional's medical school
Graduation Year	2005
	Individual professional's medical school graduation year
Primary Specialty	INTERNAL MEDICINE
	Primary medical specialty reported by the individual professional in the selected enrollment

Practice Information
Organization Legal Name	PROHEALTH PHYSICIANS 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	1355246950
	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	295
	Total number of individual professionals affiliated with the Group Practice based on Group Practice PAC ID
Line 1 Street Address	1260 SILAS DEANE HWY
	Group Practice or individual's line 1 address
Line 2 Street Address	SUITE 103
	Group Practice or individual's line 2 address
City	WETHERSFIELD
	Group Practice or individual's city
State	CT
	Group Practice or individual's state
Zip Code	061094363
	Group Practice or individual's zip code (9 digits when available)
Phone Number	8605639518
	Phone number is listed only when there is a single phone number available for the practice location address

Hospital(s) Affiliation Information
Professional Accepts Medicare Assignment	Y