Physician Compare National (NPI:1285028860)

HEALTHCARE PROVIDER: DAVIDA JACKSON

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

Individual Professional Information
NPI	1285028860
	Unique healthcare provider (clinician) ID assigned by NPPES
PECOS UID	9638489545
	Unique individual clinician ID assigned by PECOS
Professional Enrollment ID	I20151105000488
	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	DAVIDA
	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	2014
	Individual professional's medical school graduation year
Primary Specialty	PHYSICIAN ASSISTANT
	Primary medical specialty reported by the individual professional in the selected enrollment

Practice Information
Organization Legal Name	ISLAND URGENT CARE PLLC
	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	1355636440
	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	11
	Total number of individual professionals affiliated with the Group Practice based on Group Practice PAC ID
Line 1 Street Address	1037 FULTON ST
	Group Practice or individual's line 1 address
City	FARMINGDALE
	Group Practice or individual's city
State	NY
	Group Practice or individual's state
Zip Code	117354700
	Group Practice or individual's zip code (9 digits when available)
Phone Number	6315764190
	Phone number is listed only when there is a single phone number available for the practice location address

Hospital(s) Affiliation Information
Professional Accepts Medicare Assignment	Y