Physician Compare National (NPI:1497989123)

HEALTHCARE PROVIDER: JAYME LEIGH MICKELSON D.O.

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

Individual Professional Information
NPI	1497989123
	Unique healthcare provider (clinician) ID assigned by NPPES
PECOS UID	2961653738
	Unique individual clinician ID assigned by PECOS
Professional Enrollment ID	I20150130000250
	Unique ID for the individual professional enrollment that is the source for the data in the observation
Provider Last Name	MICKELSON
	Individual professional last name
Provider First Name	JAYME
	Individual professional first name
Provider Middle Name	L
	Individual professional middle name
Provider Gender	F
	The provider's gender if the provider is a person.

Medical School Information
Medical School Name	UNIVERSITY OF NEW ENGLAND, COLLEGE OF OSTEO MEDICINE
	Individual professional's medical school
Graduation Year	2009
	Individual professional's medical school graduation year
Primary Specialty	INTERNAL MEDICINE
	Primary medical specialty reported by the individual professional in the selected enrollment

Practice Information
Organization Legal Name	HARTFORD HEALTHCARE MEDICAL GROUP INC
	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	1153573902
	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	232
	Total number of individual professionals affiliated with the Group Practice based on Group Practice PAC ID
Line 1 Street Address	22 PINE ST
	Group Practice or individual's line 1 address
City	BRISTOL
	Group Practice or individual's city
State	CT
	Group Practice or individual's state
Zip Code	060106948
	Group Practice or individual's zip code (9 digits when available)
Phone Number	8605848291
	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	070035
	Medicare CCN of hospital where individual professional provides service 1
Hospital Affiliation LBN 1	THE HOSPITAL OF CENTRAL CONNECTICUT
	Legal business name of hospital where individual professional provides service 1
Hospital Affiliation CCN 2	070011
	Medicare CCN of hospital where individual professional provides service 2
Hospital Affiliation LBN 2	CHARLOTTE HUNGERFORD HOSPITAL
	Legal business name of hospital where individual professional provides service 2
Hospital Affiliation CCN 3	070029
	Medicare CCN of hospital where individual professional provides service 3
Hospital Affiliation LBN 3	BRISTOL HOSPITAL
	Legal business name of hospital where individual professional provides service 3
Hospital Affiliation CCN 4	070024
	Medicare CCN of hospital where individual professional provides service 4
Hospital Affiliation LBN 4	WILLIAM W BACKUS HOSPITAL
	Legal business name of hospital where individual professional provides service 4
Professional Accepts Medicare Assignment	Y