Physician Compare National (NPI:1073976197)

HEALTHCARE PROVIDER: JARED JOHNS D.O.

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

Individual Professional Information
NPI	1073976197
	Unique healthcare provider (clinician) ID assigned by NPPES
PECOS UID	5395090070
	Unique individual clinician ID assigned by PECOS
Professional Enrollment ID	I20200730000759
	Unique ID for the individual professional enrollment that is the source for the data in the observation
Provider Last Name	JOHNS
	Individual professional last name
Provider First Name	JARED
	Individual professional first name
Provider Gender	M
	The provider's gender if the provider is a person.

Medical School Information
Medical School Name	AT STILL UNIVERSITY OF HEALTH SCIENCES, COLLEGE OF OSTEO MED, KIRKSVILLE
	Individual professional's medical school
Graduation Year	2016
	Individual professional's medical school graduation year
Primary Specialty	EMERGENCY MEDICINE
	Primary medical specialty reported by the individual professional in the selected enrollment

Practice Information
Organization Legal Name	MERCY HOSPITAL SOUTH
	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	8426962556
	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	27
	Total number of individual professionals affiliated with the Group Practice based on Group Practice PAC ID
Line 1 Street Address	10010 KENNERLY RD
	Group Practice or individual's line 1 address
City	SAINT LOUIS
	Group Practice or individual's city
State	MO
	Group Practice or individual's state
Zip Code	631282106
	Group Practice or individual's zip code (9 digits when available)
Phone Number	3145251906
	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	260077
	Medicare CCN of hospital where individual professional provides service 1
Hospital Affiliation LBN 1	ST ANTHONY'S MEDICAL CENTER
	Legal business name of hospital where individual professional provides service 1
Hospital Affiliation CCN 2	050279
	Medicare CCN of hospital where individual professional provides service 2
Hospital Affiliation LBN 2	HI-DESERT MEDICAL CENTER
	Legal business name of hospital where individual professional provides service 2
Hospital Affiliation CCN 3	261319
	Medicare CCN of hospital where individual professional provides service 3
Hospital Affiliation LBN 3	LINCOLN COUNTY MEDICAL CENTER
	Legal business name of hospital where individual professional provides service 3
Hospital Affiliation CCN 4	050765
	Medicare CCN of hospital where individual professional provides service 4
Hospital Affiliation LBN 4	KAISER FOUNDATION HOSPITAL-MORENO VALLEY
	Legal business name of hospital where individual professional provides service 4
Professional Accepts Medicare Assignment	Y