Physician Compare National (NPI:1164421442)

HEALTHCARE PROVIDER: CAROL ANN JACKSON-GIBSON 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	1164421442
	Unique healthcare provider (clinician) ID assigned by NPPES
PECOS UID	8527118934
	Unique individual clinician ID assigned by PECOS
Professional Enrollment ID	I20100827000264
	Unique ID for the individual professional enrollment that is the source for the data in the observation
Provider Last Name	JACKSON-GIBSON
	Individual professional last name
Provider First Name	CAROL
	Individual professional first name
Provider Middle Name	ANN
	Individual professional middle name
Provider Gender	F
	The provider's gender if the provider is a person.

Medical School Information
Medical School Name	STATE UNIVERSITY OF NY UPSTATE MEDICAL UNIVERSITY
	Individual professional's medical school
Graduation Year	1985
	Individual professional's medical school graduation year
Primary Specialty	DIAGNOSTIC RADIOLOGY
	Primary medical specialty reported by the individual professional in the selected enrollment

Practice Information
Organization Legal Name	WESTERN NEW YORK MRI LLP
	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	4082684378
	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	8
	Total number of individual professionals affiliated with the Group Practice based on Group Practice PAC ID
Line 1 Street Address	222 GENESEE ST
	Group Practice or individual's line 1 address
City	BUFFALO
	Group Practice or individual's city
State	NY
	Group Practice or individual's state
Zip Code	142031512
	Group Practice or individual's zip code (9 digits when available)
Phone Number	7168552866
	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