Physician Compare National (NPI:1568484152)

HEALTHCARE PROVIDER: JACK ROY ERWIN 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	1568484152
	Unique healthcare provider (clinician) ID assigned by NPPES
PECOS UID	6709930464
	Unique individual clinician ID assigned by PECOS
Professional Enrollment ID	I20090813000771
	Unique ID for the individual professional enrollment that is the source for the data in the observation
Provider Last Name	ERWIN
	Individual professional last name
Provider First Name	JACK
	Individual professional first name
Provider Middle Name	R
	Individual professional middle name
Provider Gender	M
	The provider's gender if the provider is a person.

Medical School Information
Medical School Name	BAYLOR COLLEGE OF MEDICINE
	Individual professional's medical school
Graduation Year	1967
	Individual professional's medical school graduation year
Primary Specialty	OTOLARYNGOLOGY
	Primary medical specialty reported by the individual professional in the selected enrollment

Practice Information
Line 1 Street Address	4740 NE STALLINGS DR
	Group Practice or individual's line 1 address
City	NACOGDOCHES
	Group Practice or individual's city
State	TX
	Group Practice or individual's state
Zip Code	759651615
	Group Practice or individual's zip code (9 digits when available)
Phone Number	9365698246
	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	450656
	Medicare CCN of hospital where individual professional provides service 1
Hospital Affiliation LBN 1	NACOGDOCHES MEDICAL CENTER
	Legal business name of hospital where individual professional provides service 1
Hospital Affiliation CCN 2	450508
	Medicare CCN of hospital where individual professional provides service 2
Hospital Affiliation LBN 2	MEMORIAL HOSPITAL
	Legal business name of hospital where individual professional provides service 2
Hospital Affiliation CCN 3	450211
	Medicare CCN of hospital where individual professional provides service 3
Hospital Affiliation LBN 3	CHI ST LUKES HEALTH MEMORIAL LUFKIN
	Legal business name of hospital where individual professional provides service 3
Professional Accepts Medicare Assignment	Y