Physician Compare National (NPI:1609019314)

HEALTHCARE PROVIDER: JESSICA ROBIN BURGESS 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	1609019314
	Unique healthcare provider (clinician) ID assigned by NPPES
PECOS UID	2365755253
	Unique individual clinician ID assigned by PECOS
Professional Enrollment ID	I20150721002656
	Unique ID for the individual professional enrollment that is the source for the data in the observation
Provider Last Name	BURGESS
	Individual professional last name
Provider First Name	JESSICA
	Individual professional first name
Provider Middle Name	R.
	Individual professional middle name
Provider Gender	F
	The provider's gender if the provider is a person.

Medical School Information
Medical School Name	EASTERN VIRGINIA MEDICAL SCHOOL
	Individual professional's medical school
Graduation Year	2009
	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
Organization Legal Name	EVMS ACADEMIC PHYSICIANS AND SURGEONS HEALTH SERVICES FOUNDATION
	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	5698675510
	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	166
	Total number of individual professionals affiliated with the Group Practice based on Group Practice PAC ID
Line 1 Street Address	825 FAIRFAX AVE
	Group Practice or individual's line 1 address
Marker of address line 2 suppression	Y
	Marker that address as reported may be incomplete
City	NORFOLK
	Group Practice or individual's city
State	VA
	Group Practice or individual's state
Zip Code	235071914
	Group Practice or individual's zip code (9 digits when available)

Hospital(s) Affiliation Information
Hospital Affiliation CCN 1	490007
	Medicare CCN of hospital where individual professional provides service 1
Hospital Affiliation LBN 1	SENTARA NORFOLK GENERAL HOSPITAL
	Legal business name of hospital where individual professional provides service 1
Hospital Affiliation CCN 2	490044
	Medicare CCN of hospital where individual professional provides service 2
Hospital Affiliation LBN 2	SENTARA OBICI HOSPITAL
	Legal business name of hospital where individual professional provides service 2
Hospital Affiliation CCN 3	490046
	Medicare CCN of hospital where individual professional provides service 3
Hospital Affiliation LBN 3	SENTARA LEIGH HOSPITAL
	Legal business name of hospital where individual professional provides service 3
Hospital Affiliation CCN 4	340109
	Medicare CCN of hospital where individual professional provides service 4
Hospital Affiliation LBN 4	SENTARA ALBEMARLE MEDICAL CENTER
	Legal business name of hospital where individual professional provides service 4
Professional Accepts Medicare Assignment	Y