Physician Compare National (NPI:1629216528)

HEALTHCARE PROVIDER: JEFFERSON PEARCE FUTCH DPM

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

Individual Professional Information
NPI	1629216528
	Unique healthcare provider (clinician) ID assigned by NPPES
PECOS UID	5890831754
	Unique individual clinician ID assigned by PECOS
Professional Enrollment ID	I20091006000589
	Unique ID for the individual professional enrollment that is the source for the data in the observation
Provider Last Name	FUTCH
	Individual professional last name
Provider First Name	JEFFERSON
	Individual professional first name
Provider Middle Name	PEARCE
	Individual professional middle name
Provider Gender	M
	The provider's gender if the provider is a person.

Medical School Information
Medical School Name	TEMPLE UNIVERSITY SCHOOL OF PODIATRIC MEDICINE
	Individual professional's medical school
Graduation Year	2006
	Individual professional's medical school graduation year
Primary Specialty	PODIATRY
	Primary medical specialty reported by the individual professional in the selected enrollment

Practice Information
Line 1 Street Address	145 HILDEN RD
	Group Practice or individual's line 1 address
Line 2 Street Address	SUITE 103
	Group Practice or individual's line 2 address
City	PONTE VEDRA
	Group Practice or individual's city
State	FL
	Group Practice or individual's state
Zip Code	320818401
	Group Practice or individual's zip code (9 digits when available)

Hospital(s) Affiliation Information
Hospital Affiliation CCN 1	100088
	Medicare CCN of hospital where individual professional provides service 1
Hospital Affiliation LBN 1	BAPTIST MEDICAL CENTER JACKSONVILLE
	Legal business name of hospital where individual professional provides service 1
Professional Accepts Medicare Assignment	Y