Physician Compare National (NPI:1174593164)

HEALTHCARE PROVIDER: JACKSON BOLAND SALVANT JR. 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	1174593164
	Unique healthcare provider (clinician) ID assigned by NPPES
PECOS UID	7315071388
	Unique individual clinician ID assigned by PECOS
Professional Enrollment ID	I20100812000250
	Unique ID for the individual professional enrollment that is the source for the data in the observation
Provider Last Name	SALVANT
	Individual professional last name
Provider First Name	JACKSON
	Individual professional first name
Provider Middle Name	B.
	Individual professional middle 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	VIRGINIA COMMONWEALTH UNIVERSITY, SCHOOL OF MEDICINE
	Individual professional's medical school
Graduation Year	1994
	Individual professional's medical school graduation year
Primary Specialty	NEUROSURGERY
	Primary medical specialty reported by the individual professional in the selected enrollment

Practice Information
Organization Legal Name	RIVERSIDE PHYSICIAN SERVICES INC
	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	5092608448
	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	602
	Total number of individual professionals affiliated with the Group Practice based on Group Practice PAC ID
Line 1 Street Address	500 J CLYDE MORRIS BLVD
	Group Practice or individual's line 1 address
Marker of address line 2 suppression	Y
	Marker that address as reported may be incomplete
City	NEWPORT NEWS
	Group Practice or individual's city
State	VA
	Group Practice or individual's state
Zip Code	236011929
	Group Practice or individual's zip code (9 digits when available)

Hospital(s) Affiliation Information
Hospital Affiliation CCN 1	490052
	Medicare CCN of hospital where individual professional provides service 1
Hospital Affiliation LBN 1	RIVERSIDE REGIONAL MEDICAL CENTER
	Legal business name of hospital where individual professional provides service 1
Hospital Affiliation CCN 2	490130
	Medicare CCN of hospital where individual professional provides service 2
Hospital Affiliation LBN 2	RIVERSIDE WALTER REED HOSPITAL
	Legal business name of hospital where individual professional provides service 2
Hospital Affiliation CCN 3	490084
	Medicare CCN of hospital where individual professional provides service 3
Hospital Affiliation LBN 3	RIVERSIDE TAPPAHANNOCK HOSPITAL
	Legal business name of hospital where individual professional provides service 3
Professional Accepts Medicare Assignment	Y