Physician Compare National (NPI:1659330108)

HEALTHCARE PROVIDER: DEWEY THOMAS JACKSON MD

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

Individual Professional Information
NPI	1659330108
	Unique healthcare provider (clinician) ID assigned by NPPES
PECOS UID	0244429579
	Unique individual clinician ID assigned by PECOS
Professional Enrollment ID	I20110118000707
	Unique ID for the individual professional enrollment that is the source for the data in the observation
Provider Last Name	JACKSON
	Individual professional last name
Provider First Name	DEWEY
	Individual professional first name
Provider Middle Name	T
	Individual professional middle name
Provider Gender	M
	The provider's gender if the provider is a person.

Medical School Information
Medical School Name	OTHER
	Individual professional's medical school
Graduation Year	1976
	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
Line 1 Street Address	2828 BAIRD RD
	Group Practice or individual's line 1 address
City	FAIRPORT
	Group Practice or individual's city
State	NY
	Group Practice or individual's state
Zip Code	144501247
	Group Practice or individual's zip code (9 digits when available)
Phone Number	5852489670
	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	330285
	Medicare CCN of hospital where individual professional provides service 1
Hospital Affiliation LBN 1	STRONG MEMORIAL HOSPITAL
	Legal business name of hospital where individual professional provides service 1
Professional Accepts Medicare Assignment	M