Physician Compare National (NPI:1669407003)

HEALTHCARE PROVIDER: HORACE J 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	1669407003
	Unique healthcare provider (clinician) ID assigned by NPPES
PECOS UID	1951478569
	Unique individual clinician ID assigned by PECOS
Professional Enrollment ID	I20080924000202
	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	HORACE
	Individual professional first name
Provider Middle Name	J
	Individual professional middle name
Provider Gender	M
	The provider's gender if the provider is a person.

Medical School Information
Medical School Name	HOWARD UNIVERSITY COLLEGE OF MEDICINE
	Individual professional's medical school
Graduation Year	1976
	Individual professional's medical school graduation year
Primary Specialty	GASTROENTEROLOGY
	Primary medical specialty reported by the individual professional in the selected enrollment
Secondary Specialty 1	INTERNAL MEDICINE
	First secondary medical specialty reported by the individual professional in the selected enrollment
All Secondary Specialties	INTERNAL MEDICINE
	All four secondary specialties reported by the individual professional in the selected enrollment, separated by commas

Practice Information
Line 1 Street Address	5000 MONUMENT AVE
	Group Practice or individual's line 1 address
Line 2 Street Address	SUITE 103
	Group Practice or individual's line 2 address
City	RICHMOND
	Group Practice or individual's city
State	VA
	Group Practice or individual's state
Zip Code	232303627
	Group Practice or individual's zip code (9 digits when available)
Phone Number	8047880556
	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	490094
	Medicare CCN of hospital where individual professional provides service 1
Hospital Affiliation LBN 1	BON SECOURS RICHMOND COMMUNITY HOSPITAL
	Legal business name of hospital where individual professional provides service 1
Hospital Affiliation CCN 2	490069
	Medicare CCN of hospital where individual professional provides service 2
Hospital Affiliation LBN 2	BON SECOURS MEMORIAL REGIONAL MEDICAL CENTER
	Legal business name of hospital where individual professional provides service 2
Hospital Affiliation CCN 3	490059
	Medicare CCN of hospital where individual professional provides service 3
Hospital Affiliation LBN 3	BON SECOURS ST MARYS HOSPITAL
	Legal business name of hospital where individual professional provides service 3
Professional Accepts Medicare Assignment	Y