Physician Compare National (NPI:1154435899)

HEALTHCARE PROVIDER: PAUL THOMAS JACKSON JR. 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	1154435899
	Unique healthcare provider (clinician) ID assigned by NPPES
PECOS UID	7618039686
	Unique individual clinician ID assigned by PECOS
Professional Enrollment ID	I20101103000115
	Unique ID for the individual professional enrollment that is the source for the data in the observation
Provider Last Name	JACKSON
	Individual professional last name
Provider First Name	PAUL
	Individual professional first name
Provider Name Suffix Text	JR.
	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	NEW YORK MEDICAL COLLEGE
	Individual professional's medical school
Graduation Year	1994
	Individual professional's medical school graduation year
Primary Specialty	INTERNAL MEDICINE
	Primary medical specialty reported by the individual professional in the selected enrollment
Secondary Specialty 1	EMERGENCY MEDICINE
	First secondary medical specialty reported by the individual professional in the selected enrollment
Secondary Specialty 2	GERIATRIC MEDICINE
	Second secondary medical specialty reported by the individual professional in the selected enrollment
Secondary Specialty 3	PREVENTATIVE MEDICINE
	Third secondary medical specialty reported by the individual professional in the selected enrollment
All Secondary Specialties	EMERGENCY MEDICINE, GERIATRIC MEDICINE, PREVENTATIVE MEDICINE
	All four secondary specialties reported by the individual professional in the selected enrollment, separated by commas

Practice Information
Line 1 Street Address	4550 LAMAR AVE
	Group Practice or individual's line 1 address
Line 2 Street Address	SUITE 200
	Group Practice or individual's line 2 address
City	PARIS
	Group Practice or individual's city
State	TX
	Group Practice or individual's state
Zip Code	754625129
	Group Practice or individual's zip code (9 digits when available)
Phone Number	9037392888
	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	450196
	Medicare CCN of hospital where individual professional provides service 1
Hospital Affiliation LBN 1	PARIS REGIONAL MEDICAL CENTER
	Legal business name of hospital where individual professional provides service 1
Professional Accepts Medicare Assignment	Y