Physician Compare National (NPI:1245330950)

HEALTHCARE PROVIDER: THOMAS E JACKSON 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	1245330950
	Unique healthcare provider (clinician) ID assigned by NPPES
PECOS UID	0446384325
	Unique individual clinician ID assigned by PECOS
Professional Enrollment ID	I20100813000490
	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	THOMAS
	Individual professional first name
Provider Middle Name	EDWARD
	Individual professional middle name
Provider Gender	M
	The provider's gender if the provider is a person.

Medical School Information
Medical School Name	OTHER
	Individual professional's medical school
Graduation Year	1981
	Individual professional's medical school graduation year
Primary Specialty	INTERNAL MEDICINE
	Primary medical specialty reported by the individual professional in the selected enrollment

Practice Information
Line 1 Street Address	47 MAPLE ST
	Group Practice or individual's line 1 address
Line 2 Street Address	SUITE 205
	Group Practice or individual's line 2 address
City	SUMMIT
	Group Practice or individual's city
State	NJ
	Group Practice or individual's state
Zip Code	079012571
	Group Practice or individual's zip code (9 digits when available)
Phone Number	9085229400
	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	310051
	Medicare CCN of hospital where individual professional provides service 1
Hospital Affiliation LBN 1	OVERLOOK MEDICAL CENTER
	Legal business name of hospital where individual professional provides service 1
Professional Accepts Medicare Assignment	Y