Physician Compare National (NPI:1245280726)

HEALTHCARE PROVIDER:

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

Individual Professional Information
NPI	1245280726
	Unique healthcare provider (clinician) ID assigned by NPPES
PECOS UID	4486622289
	Unique individual clinician ID assigned by PECOS
Professional Enrollment ID	I20040920000858
	Unique ID for the individual professional enrollment that is the source for the data in the observation
Provider Last Name	DAVIS
	Individual professional last name
Provider First Name	JESSE
	Individual professional first name
Provider Middle Name	T
	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.
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	UNIVERSITY OF MISSISSIPPI SCHOOL OF MEDICINE
	Individual professional's medical school
Graduation Year	1963
	Individual professional's medical school graduation year
Primary Specialty	VASCULAR SURGERY
	Primary medical specialty reported by the individual professional in the selected enrollment

Practice Information
Line 1 Street Address	8000 CENTERVIEW PKWY
	Group Practice or individual's line 1 address
Line 2 Street Address	SUITE 103
	Group Practice or individual's line 2 address
City	CORDOVA
	Group Practice or individual's city
State	TN
	Group Practice or individual's state
Zip Code	380184264
	Group Practice or individual's zip code (9 digits when available)
Phone Number	9017568541
	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	250128
	Medicare CCN of hospital where individual professional provides service 1
Hospital Affiliation LBN 1	PANOLA MEDICAL CENTER
	Legal business name of hospital where individual professional provides service 1
Professional Accepts Medicare Assignment	Y