Physician Compare National (NPI:1245344571)

HEALTHCARE PROVIDER: JESSE WAYNE JOHNSON 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	1245344571
	Unique healthcare provider (clinician) ID assigned by NPPES
PECOS UID	5597757161
	Unique individual clinician ID assigned by PECOS
Professional Enrollment ID	I20080910000530
	Unique ID for the individual professional enrollment that is the source for the data in the observation
Provider Last Name	JOHNSON
	Individual professional last name
Provider First Name	JESSE
	Individual professional first name
Provider Middle Name	WAYNE
	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	UNIVERSITY OF FLORIDA COLLEGE OF MEDICINE
	Individual professional's medical school
Graduation Year	1984
	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
Organization Legal Name	HEATHROW INTERNAL MEDICINE LLC
	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	5294801536
	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	12
	Total number of individual professionals affiliated with the Group Practice based on Group Practice PAC ID
Line 1 Street Address	4106 W LAKE MARY BLVD
	Group Practice or individual's line 1 address
Line 2 Street Address	SUITE 100
	Group Practice or individual's line 2 address
City	LAKE MARY
	Group Practice or individual's city
State	FL
	Group Practice or individual's state
Zip Code	327463344
	Group Practice or individual's zip code (9 digits when available)
Phone Number	4073332273
	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	100007
	Medicare CCN of hospital where individual professional provides service 1
Hospital Affiliation LBN 1	FLORIDA HOSPITAL
	Legal business name of hospital where individual professional provides service 1
Hospital Affiliation CCN 2	100161
	Medicare CCN of hospital where individual professional provides service 2
Hospital Affiliation LBN 2	CENTRAL FLORIDA REGIONAL HOSPITAL
	Legal business name of hospital where individual professional provides service 2
Hospital Affiliation CCN 3	100045
	Medicare CCN of hospital where individual professional provides service 3
Hospital Affiliation LBN 3	FLORIDA HOSPITAL DELAND
	Legal business name of hospital where individual professional provides service 3
Professional Accepts Medicare Assignment	Y