Physician Compare National (NPI:1699777854)

HEALTHCARE PROVIDER: GREGG ALAN DICKERSON M.D.

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

Individual Professional Information
NPI	1699777854
	Unique healthcare provider (clinician) ID assigned by NPPES
PECOS UID	3274633870
	Unique individual clinician ID assigned by PECOS
Professional Enrollment ID	I20161214000078
	Unique ID for the individual professional enrollment that is the source for the data in the observation
Provider Last Name	DICKERSON
	Individual professional last name
Provider First Name	GREGG
	Individual professional first name
Provider Middle Name	A
	Individual professional middle name
Provider Gender	M
	The provider's gender if the provider is a person.

Medical School Information
Medical School Name	INDIANA UNIVERSITY SCHOOL OF MEDICINE
	Individual professional's medical school
Graduation Year	1984
	Individual professional's medical school graduation year
Primary Specialty	RADIATION ONCOLOGY
	Primary medical specialty reported by the individual professional in the selected enrollment

Practice Information
Line 1 Street Address	1514 E UNION ST
	Group Practice or individual's line 1 address
Line 2 Street Address	ALLIANCE CANCER CENTER
	Group Practice or individual's line 2 address
City	GREENVILLE
	Group Practice or individual's city
State	MS
	Group Practice or individual's state
Zip Code	387033248
	Group Practice or individual's zip code (9 digits when available)

Hospital(s) Affiliation Information
Hospital Affiliation CCN 1	250082
	Medicare CCN of hospital where individual professional provides service 1
Hospital Affiliation LBN 1	DELTA REGIONAL MEDICAL CENTER
	Legal business name of hospital where individual professional provides service 1
Professional Accepts Medicare Assignment	Y