Physician Compare National (NPI:1306894423)

HEALTHCARE PROVIDER: MARK DAVID JACOBSON 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	1306894423
	Unique healthcare provider (clinician) ID assigned by NPPES
PECOS UID	6103900576
	Unique individual clinician ID assigned by PECOS
Professional Enrollment ID	I20090317000185
	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	MARK
	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	OTHER
	Individual professional's medical school
Graduation Year	1988
	Individual professional's medical school graduation year
Primary Specialty	DIAGNOSTIC RADIOLOGY
	Primary medical specialty reported by the individual professional in the selected enrollment
Secondary Specialty 1	INTERVENTIONAL RADIOLOGY
	First secondary medical specialty reported by the individual professional in the selected enrollment
All Secondary Specialties	INTERVENTIONAL RADIOLOGY
	All four secondary specialties reported by the individual professional in the selected enrollment, separated by commas

Practice Information
Organization Legal Name	INVERNESS MEDICAL IMAGING, 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	3870590672
	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	3
	Total number of individual professionals affiliated with the Group Practice based on Group Practice PAC ID
Line 1 Street Address	2105 HWY 44 W
	Group Practice or individual's line 1 address
City	INVERNESS
	Group Practice or individual's city
State	FL
	Group Practice or individual's state
Zip Code	344523805
	Group Practice or individual's zip code (9 digits when available)
Phone Number	3524194818
	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	100244
	Medicare CCN of hospital where individual professional provides service 1
Hospital Affiliation LBN 1	CAPE CORAL HOSPITAL - 100244
	Legal business name of hospital where individual professional provides service 1
Professional Accepts Medicare Assignment	Y