Physician Compare National (NPI:1619903580)

HEALTHCARE PROVIDER: JAMES WILFRED ERVIN JR. 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	1619903580
	Unique healthcare provider (clinician) ID assigned by NPPES
PECOS UID	9638157332
	Unique individual clinician ID assigned by PECOS
Professional Enrollment ID	I20040712001528
	Unique ID for the individual professional enrollment that is the source for the data in the observation
Provider Last Name	ERVIN
	Individual professional last name
Provider First Name	JAMES
	Individual professional first name
Provider Middle Name	W
	Individual professional middle name
Provider Gender	M
	The provider's gender if the provider is a person.
Provider Credential Text	MD
	The abbreviations for professional degrees or credentials used or held by the provider, if the provider is an individual. Examples are MD, DDS, CSW, CNA, AA, NP, RNA, or PSY. These credential designations will not be verified by NPS.

Medical School Information
Medical School Name	UNIVERSITY OF MISSISSIPPI SCHOOL OF MEDICINE
	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

Practice Information
Organization Legal Name	FAMILY MEDICAL CLINIC OF CRYSTAL SPRINGS PLLC
	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	6002894706
	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	3
	Total number of individual professionals affiliated with the Group Practice based on Group Practice PAC ID
Line 1 Street Address	104 W RAILROAD AVE S
	Group Practice or individual's line 1 address
City	CRYSTAL SPRINGS
	Group Practice or individual's city
State	MS
	Group Practice or individual's state
Zip Code	390592111
	Group Practice or individual's zip code (9 digits when available)
Phone Number	6018923063
	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	251327
	Medicare CCN of hospital where individual professional provides service 1
Hospital Affiliation LBN 1	COPIAH COUNTY MEDICAL CENTER
	Legal business name of hospital where individual professional provides service 1
Hospital Affiliation CCN 2	250102
	Medicare CCN of hospital where individual professional provides service 2
Hospital Affiliation LBN 2	MISSISSIPPI BAPTIST MEDICAL CENTER
	Legal business name of hospital where individual professional provides service 2
Hospital Affiliation CCN 3	250048
	Medicare CCN of hospital where individual professional provides service 3
Hospital Affiliation LBN 3	ST DOMINIC-JACKSON MEMORIAL HOSPITAL
	Legal business name of hospital where individual professional provides service 3
Hospital Affiliation CCN 4	250057
	Medicare CCN of hospital where individual professional provides service 4
Hospital Affiliation LBN 4	KING'S DAUGHTERS MEDICAL CENTER-BROOKHAVEN
	Legal business name of hospital where individual professional provides service 4
Professional Accepts Medicare Assignment	Y