Individual Professional Information |
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NPI
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1760429369
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Unique healthcare provider (clinician) ID assigned by NPPES
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PECOS UID
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1254358575
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Unique individual clinician ID assigned by PECOS
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Professional Enrollment ID
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I20051026000827
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Unique ID for the individual professional enrollment that is the source for the data in the observation
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Provider Last Name
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FALLON
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Individual professional last name
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Provider First Name
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JOSEPH
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Individual professional first name
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Provider Middle Name
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J
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Individual professional middle name
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Provider Name Suffix Text
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JR.
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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.
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Provider Gender
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M
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The provider's gender if the provider is a person.
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Provider Credential Text
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MD
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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.
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Medical School Information |
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Medical School Name
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R FRANKLIN UNIVERSITY OF MED & SCI/CHICAGO MEDICAL SCHOOL
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Individual professional's medical school
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Graduation Year
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1979
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Individual professional's medical school graduation year
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Primary Specialty
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ENDOCRINOLOGY
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Primary medical specialty reported by the individual professional in the selected enrollment
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Secondary Specialty 1
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INTERNAL MEDICINE
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First secondary medical specialty reported by the individual professional in the selected enrollment
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All Secondary Specialties
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INTERNAL MEDICINE
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All four secondary specialties reported by the individual professional in the selected enrollment, separated by commas
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Hospital(s) Affiliation Information |
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Hospital Affiliation CCN 1
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310022
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Medicare CCN of hospital where individual professional provides service 1
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Hospital Affiliation LBN 1
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VIRTUA WEST JERSEY HOSPITALS
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Legal business name of hospital where individual professional provides service 1
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Hospital Affiliation CCN 2
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390223
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Medicare CCN of hospital where individual professional provides service 2
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Hospital Affiliation LBN 2
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PENN PRESBYTERIAN MEDICAL CENTER
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Legal business name of hospital where individual professional provides service 2
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Hospital Affiliation CCN 3
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310032
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Medicare CCN of hospital where individual professional provides service 3
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Hospital Affiliation LBN 3
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INSPIRA MEDICAL CENTER VINELAND
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Legal business name of hospital where individual professional provides service 3
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Hospital Affiliation CCN 4
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310014
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Medicare CCN of hospital where individual professional provides service 4
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Hospital Affiliation LBN 4
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COOPER UNIVERSITY HOSPITAL
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Legal business name of hospital where individual professional provides service 4
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Hospital Affiliation CCN 5
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310064
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Medicare CCN of hospital where individual professional provides service 5
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Hospital Affiliation LBN 5
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ATLANTICARE REGIONAL MEDICAL CENTER
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Legal business name of hospital where individual professional provides service 5
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Professional Accepts Medicare Assignment
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Y
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