Physician Compare National (NPI:1386639300)

HEALTHCARE PROVIDER:

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

Individual Professional Information
NPI	1386639300
	Unique healthcare provider (clinician) ID assigned by NPPES
PECOS UID	8628159076
	Unique individual clinician ID assigned by PECOS
Professional Enrollment ID	I20080225000518
	Unique ID for the individual professional enrollment that is the source for the data in the observation
Provider Last Name	SHERRILL
	Individual professional last name
Provider First Name	JOHN
	Individual professional first name
Provider Gender	M
	The provider's gender if the provider is a person.

Medical School Information
Medical School Name	UNIVERSITY OF SOUTH ALABAMA COLLEGE OF MEDICINE
	Individual professional's medical school
Graduation Year	1984
	Individual professional's medical school graduation year
Primary Specialty	FAMILY MEDICINE
	Primary medical specialty reported by the individual professional in the selected enrollment

Practice Information
Line 1 Street Address	607 HOLSTON AVE
	Group Practice or individual's line 1 address
Line 2 Street Address	B
	Group Practice or individual's line 2 address
City	BRISTOL
	Group Practice or individual's city
State	TN
	Group Practice or individual's state
Zip Code	376203592
	Group Practice or individual's zip code (9 digits when available)
Phone Number	4239681772
	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	440012
	Medicare CCN of hospital where individual professional provides service 1
Hospital Affiliation LBN 1	WELLMONT BRISTOL REGIONAL MEDICAL CENTER
	Legal business name of hospital where individual professional provides service 1
Professional Accepts Medicare Assignment	Y