Physician Compare National (NPI:1356534952)

HEALTHCARE PROVIDER: JASON FOWLKES 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	1356534952
	Unique healthcare provider (clinician) ID assigned by NPPES
PECOS UID	0345389706
	Unique individual clinician ID assigned by PECOS
Professional Enrollment ID	I20091125000258
	Unique ID for the individual professional enrollment that is the source for the data in the observation
Provider Last Name	FOWLKES
	Individual professional last name
Provider First Name	JASON
	Individual professional first 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	2004
	Individual professional's medical school graduation year
Primary Specialty	GENERAL SURGERY
	Primary medical specialty reported by the individual professional in the selected enrollment

Practice Information
Line 1 Street Address	801 DAVIS ST
	Group Practice or individual's line 1 address
Line 2 Street Address	SUITE 1
	Group Practice or individual's line 2 address
City	BLACKSBURG
	Group Practice or individual's city
State	VA
	Group Practice or individual's state
Zip Code	240607022
	Group Practice or individual's zip code (9 digits when available)

Hospital(s) Affiliation Information
Hospital Affiliation CCN 1	490110
	Medicare CCN of hospital where individual professional provides service 1
Hospital Affiliation LBN 1	LEWISGALE HOSPITAL MONTGOMERY
	Legal business name of hospital where individual professional provides service 1
Hospital Affiliation CCN 2	490116
	Medicare CCN of hospital where individual professional provides service 2
Hospital Affiliation LBN 2	LEWISGALE HOSPITAL PULASKI
	Legal business name of hospital where individual professional provides service 2
Professional Accepts Medicare Assignment	Y