Physician Compare National (NPI:1689601320)

HEALTHCARE PROVIDER: BOBBY LEWIS COCKRAM JR. PA

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

Individual Professional Information
NPI	1689601320
	Unique healthcare provider (clinician) ID assigned by NPPES
PECOS UID	9234124686
	Unique individual clinician ID assigned by PECOS
Professional Enrollment ID	I20130521000665
	Unique ID for the individual professional enrollment that is the source for the data in the observation
Provider Last Name	COCKRAM
	Individual professional last name
Provider First Name	BOBBY
	Individual professional first name
Provider Middle Name	LEWIS
	Individual professional middle name
Provider Name Suffix Text	JR.
	The name suffix of the provider if the provider is an individual. The name suffix is a ''generation-related'' suffix, such as Jr., Sr., II, III, IV, or V.
Provider Gender	M
	The provider's gender if the provider is a person.
Provider Credential Text	PA
	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	OTHER
	Individual professional's medical school
Graduation Year	2011
	Individual professional's medical school graduation year
Primary Specialty	PHYSICIAN ASSISTANT
	Primary medical specialty reported by the individual professional in the selected enrollment

Practice Information
Organization Legal Name	INOVA HEALTH CARE SERVICES
	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	2466351093
	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	967
	Total number of individual professionals affiliated with the Group Practice based on Group Practice PAC ID
Line 1 Street Address	3300 GALLOWS RD
	Group Practice or individual's line 1 address
City	FALLS CHURCH
	Group Practice or individual's city
State	VA
	Group Practice or individual's state
Zip Code	220423307
	Group Practice or individual's zip code (9 digits when available)

Hospital(s) Affiliation Information
Hospital Affiliation CCN 1	490063
	Medicare CCN of hospital where individual professional provides service 1
Hospital Affiliation LBN 1	INOVA FAIRFAX HOSPITAL
	Legal business name of hospital where individual professional provides service 1
Hospital Affiliation CCN 2	490122
	Medicare CCN of hospital where individual professional provides service 2
Hospital Affiliation LBN 2	INOVA MOUNT VERNON HOSPITAL
	Legal business name of hospital where individual professional provides service 2
Professional Accepts Medicare Assignment	Y