Physician Compare National (NPI:1669679569)

HEALTHCARE PROVIDER: CHRISTOPHER MARK JOHN D.O.

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

Individual Professional Information
NPI	1669679569
	Unique healthcare provider (clinician) ID assigned by NPPES
PECOS UID	6002047370
	Unique individual clinician ID assigned by PECOS
Professional Enrollment ID	I20191113000230
	Unique ID for the individual professional enrollment that is the source for the data in the observation
Provider Last Name	JOHN
	Individual professional last name
Provider First Name	CHRISTOPHER
	Individual professional first name
Provider Middle Name	M
	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	1997
	Individual professional's medical school graduation year
Primary Specialty	DIAGNOSTIC RADIOLOGY
	Primary medical specialty reported by the individual professional in the selected enrollment
Secondary Specialty 1	INTERVENTIONAL RADIOLOGY
	First secondary medical specialty reported by the individual professional in the selected enrollment
All Secondary Specialties	INTERVENTIONAL RADIOLOGY
	All four secondary specialties reported by the individual professional in the selected enrollment, separated by commas

Practice Information
Organization Legal Name	MORI BEAN AND BROOKS INC
	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	8820077878
	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	200
	Total number of individual professionals affiliated with the Group Practice based on Group Practice PAC ID
Line 1 Street Address	3599 UNIVERSITY BLVD S
	Group Practice or individual's line 1 address
Line 2 Street Address	SUITE 300
	Group Practice or individual's line 2 address
City	JACKSONVILLE
	Group Practice or individual's city
State	FL
	Group Practice or individual's state
Zip Code	322164245
	Group Practice or individual's zip code (9 digits when available)
Phone Number	9043995550
	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	110146
	Medicare CCN of hospital where individual professional provides service 1
Hospital Affiliation LBN 1	SOUTHEAST GEORGIA HEALTH SYSTEM -- CAMDEN CAMPUS
	Legal business name of hospital where individual professional provides service 1
Hospital Affiliation CCN 2	110003
	Medicare CCN of hospital where individual professional provides service 2
Hospital Affiliation LBN 2	MAYO CLINIC HEALTH SYSTEM IN WAYCROSS
	Legal business name of hospital where individual professional provides service 2
Hospital Affiliation CCN 3	100179
	Medicare CCN of hospital where individual professional provides service 3
Hospital Affiliation LBN 3	MEMORIAL HOSPITAL JACKSONVILLE
	Legal business name of hospital where individual professional provides service 3
Hospital Affiliation CCN 4	110025
	Medicare CCN of hospital where individual professional provides service 4
Hospital Affiliation LBN 4	SOUTHEAST GEORGIA HEALTH SYSTEM- BRUNSWICK CAMPUS
	Legal business name of hospital where individual professional provides service 4
Professional Accepts Medicare Assignment	Y