Physician Compare National (NPI:1720280753)

HEALTHCARE PROVIDER: JARED B PETTY DO

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

Individual Professional Information
NPI	1720280753
	Unique healthcare provider (clinician) ID assigned by NPPES
PECOS UID	8022162759
	Unique individual clinician ID assigned by PECOS
Professional Enrollment ID	I20090814000519
	Unique ID for the individual professional enrollment that is the source for the data in the observation
Provider Last Name	PETTY
	Individual professional last name
Provider First Name	JARED
	Individual professional first name
Provider Middle Name	B
	Individual professional middle name
Provider Gender	M
	The provider's gender if the provider is a person.

Medical School Information
Medical School Name	ARIZONA COLLEGE OF OSTEOPATHIC MEDICINE MID WESTERN UNIVERSITY
	Individual professional's medical school
Graduation Year	2006
	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	209 E BROADWAY ST
	Group Practice or individual's line 1 address
Line 2 Street Address	WINNSBORO INTERNAL MEDICINE
	Group Practice or individual's line 2 address
City	WINNSBORO
	Group Practice or individual's city
State	TX
	Group Practice or individual's state
Zip Code	754942604
	Group Practice or individual's zip code (9 digits when available)

Hospital(s) Affiliation Information
Hospital Affiliation CCN 1	450801
	Medicare CCN of hospital where individual professional provides service 1
Hospital Affiliation LBN 1	CHRISTUS ST MICHAEL HEALTH SYSTEM
	Legal business name of hospital where individual professional provides service 1
Hospital Affiliation CCN 2	451381
	Medicare CCN of hospital where individual professional provides service 2
Hospital Affiliation LBN 2	CHRISTUS MOTHER FRANCES HOSPITAL- WINNSBORO
	Legal business name of hospital where individual professional provides service 2
Hospital Affiliation CCN 3	450083
	Medicare CCN of hospital where individual professional provides service 3
Hospital Affiliation LBN 3	EAST TEXAS MEDICAL CENTER
	Legal business name of hospital where individual professional provides service 3
Hospital Affiliation CCN 4	450102
	Medicare CCN of hospital where individual professional provides service 4
Hospital Affiliation LBN 4	MOTHER FRANCES HOSPITAL
	Legal business name of hospital where individual professional provides service 4
Hospital Affiliation CCN 5	450196
	Medicare CCN of hospital where individual professional provides service 5
Hospital Affiliation LBN 5	PARIS REGIONAL MEDICAL CENTER
	Legal business name of hospital where individual professional provides service 5
Professional Accepts Medicare Assignment	Y

Physician Compare National (NPI:1720280753)

HEALTHCARE PROVIDER: JARED B PETTY DO

Individual Professional Information

Medical School Information

Practice Information

Hospital(s) Affiliation Information