Physician Compare National (NPI:1386794816)

HEALTHCARE PROVIDER: LAWRENCE RICHARD JACKSON JR. MD

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

Individual Professional Information
NPI	1386794816
	Unique healthcare provider (clinician) ID assigned by NPPES
PECOS UID	5698764298
	Unique individual clinician ID assigned by PECOS
Professional Enrollment ID	I20090702000018
	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	LAWRENCE
	Individual professional first name
Provider Middle Name	R
	Individual professional middle name
Provider Name Suffix Text	JR.
	The name suffix of the provider if the provider is an individual. The name suffix is a ''generation-related'' suffix, such as Jr., Sr., II, III, IV, or V.
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	1986
	Individual professional's medical school graduation year
Primary Specialty	FAMILY MEDICINE
	Primary medical specialty reported by the individual professional in the selected enrollment
Secondary Specialty 1	EMERGENCY MEDICINE
	First secondary medical specialty reported by the individual professional in the selected enrollment
All Secondary Specialties	EMERGENCY MEDICINE
	All four secondary specialties reported by the individual professional in the selected enrollment, separated by commas

Practice Information
Line 1 Street Address	451 HWY 13 S
	Group Practice or individual's line 1 address
City	WAVERLY
	Group Practice or individual's city
State	TN
	Group Practice or individual's state
Zip Code	371852109
	Group Practice or individual's zip code (9 digits when available)

Hospital(s) Affiliation Information
Hospital Affiliation CCN 1	441303
	Medicare CCN of hospital where individual professional provides service 1
Hospital Affiliation LBN 1	THREE RIVERS HOSPITAL
	Legal business name of hospital where individual professional provides service 1
Hospital Affiliation CCN 2	440046
	Medicare CCN of hospital where individual professional provides service 2
Hospital Affiliation LBN 2	TRISTAR HORIZON MEDICAL CENTER
	Legal business name of hospital where individual professional provides service 2
Professional Accepts Medicare Assignment	Y