Physician Compare National (NPI:1144380205)

HEALTHCARE PROVIDER: MITCHEL JACOBS 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	1144380205
	Unique healthcare provider (clinician) ID assigned by NPPES
PECOS UID	2860595105
	Unique individual clinician ID assigned by PECOS
Professional Enrollment ID	I20070307000291
	Unique ID for the individual professional enrollment that is the source for the data in the observation
Provider Last Name	JACOBS
	Individual professional last name
Provider First Name	MITCHEL
	Individual professional first name
Provider Gender	M
	The provider's gender if the provider is a person.
Provider Credential Text	MD
	The abbreviations for professional degrees or credentials used or held by the provider, if the provider is an individual. Examples are MD, DDS, CSW, CNA, AA, NP, RNA, or PSY. These credential designations will not be verified by NPS.

Medical School Information
Medical School Name	OTHER
	Individual professional's medical school
Graduation Year	1985
	Individual professional's medical school graduation year
Primary Specialty	PULMONARY DISEASE
	Primary medical specialty reported by the individual professional in the selected enrollment
Secondary Specialty 1	CRITICAL CARE (INTENSIVISTS)
	First secondary medical specialty reported by the individual professional in the selected enrollment
All Secondary Specialties	CRITICAL CARE (INTENSIVISTS)
	All four secondary specialties reported by the individual professional in the selected enrollment, separated by commas

Practice Information
Organization Legal Name	NASSAU PULMONARY AND CRITICAL CARE MEDICINE 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	1355448127
	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	5
	Total number of individual professionals affiliated with the Group Practice based on Group Practice PAC ID
Line 1 Street Address	891 NORTHERN BLVD
	Group Practice or individual's line 1 address
Line 2 Street Address	SUITE 203
	Group Practice or individual's line 2 address
City	GREAT NECK
	Group Practice or individual's city
State	NY
	Group Practice or individual's state
Zip Code	110215305
	Group Practice or individual's zip code (9 digits when available)
Phone Number	5167736300
	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	330106
	Medicare CCN of hospital where individual professional provides service 1
Hospital Affiliation LBN 1	NS/LIJ HS-NORTH SHORE UNIVERSITY HOSPITAL AT MANHASSET
	Legal business name of hospital where individual professional provides service 1
Professional Accepts Medicare Assignment	Y