Physician Compare National (NPI:1275950032)

HEALTHCARE PROVIDER: JERILYNN JACOBSON

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

Individual Professional Information
NPI	1275950032
	Unique healthcare provider (clinician) ID assigned by NPPES
PECOS UID	5698080026
	Unique individual clinician ID assigned by PECOS
Professional Enrollment ID	I20150813012465
	Unique ID for the individual professional enrollment that is the source for the data in the observation
Provider Last Name	JACOBSON
	Individual professional last name
Provider First Name	JERILYNN
	Individual professional first name
Provider Gender	F
	The provider's gender if the provider is a person.

Medical School Information
Medical School Name	OTHER
	Individual professional's medical school
Graduation Year	2009
	Individual professional's medical school graduation year
Primary Specialty	CLINICAL SOCIAL WORKER
	Primary medical specialty reported by the individual professional in the selected enrollment

Practice Information
Line 1 Street Address	6678 DIXIE HWY
	Group Practice or individual's line 1 address
Line 2 Street Address	SUITE 110
	Group Practice or individual's line 2 address
City	CLARKSTON
	Group Practice or individual's city
State	MI
	Group Practice or individual's state
Zip Code	483462916
	Group Practice or individual's zip code (9 digits when available)

Hospital(s) Affiliation Information
Professional Accepts Medicare Assignment	Y