Physician Compare National (NPI:1285845040)

HEALTHCARE PROVIDER: JEFFREY DOUGLAS DICKSON 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	1285845040
	Unique healthcare provider (clinician) ID assigned by NPPES
PECOS UID	1557451655
	Unique individual clinician ID assigned by PECOS
Professional Enrollment ID	I20071212000803
	Unique ID for the individual professional enrollment that is the source for the data in the observation
Provider Last Name	DICKSON
	Individual professional last name
Provider First Name	JEFFREY
	Individual professional first name
Provider Middle Name	D
	Individual professional middle name
Provider Gender	M
	The provider's gender if the provider is a person.

Medical School Information
Medical School Name	EASTERN VIRGINIA MEDICAL SCHOOL
	Individual professional's medical school
Graduation Year	1996
	Individual professional's medical school graduation year
Primary Specialty	EMERGENCY MEDICINE
	Primary medical specialty reported by the individual professional in the selected enrollment

Practice Information
Organization Legal Name	EMERGENCY MEDICINE ASSOCIATES PA PC
	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	8022914522
	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	407
	Total number of individual professionals affiliated with the Group Practice based on Group Practice PAC ID
Line 1 Street Address	24440 STONE SPRINGS BLVD
	Group Practice or individual's line 1 address
City	DULLES
	Group Practice or individual's city
State	VA
	Group Practice or individual's state
Zip Code	201662247
	Group Practice or individual's zip code (9 digits when available)
Phone Number	2406862300
	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	490041
	Medicare CCN of hospital where individual professional provides service 1
Hospital Affiliation LBN 1	BON SECOURS MARY IMMACULATE HOSPITAL
	Legal business name of hospital where individual professional provides service 1
Hospital Affiliation CCN 2	490011
	Medicare CCN of hospital where individual professional provides service 2
Hospital Affiliation LBN 2	BON SECOURS DEPAUL MEDICAL CENTER
	Legal business name of hospital where individual professional provides service 2
Professional Accepts Medicare Assignment	Y