Physician Compare National (NPI:1770757130)

HEALTHCARE PROVIDER: JACOB MAXWELL-PHILLIP BLOOM MD

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

Individual Professional Information
NPI	1770757130
	Unique healthcare provider (clinician) ID assigned by NPPES
PECOS UID	9739304981
	Unique individual clinician ID assigned by PECOS
Professional Enrollment ID	I20140702001968
	Unique ID for the individual professional enrollment that is the source for the data in the observation
Provider Last Name	BLOOM
	Individual professional last name
Provider First Name	JACOB
	Individual professional first name
Provider Middle Name	MP
	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	2008
	Individual professional's medical school graduation year
Primary Specialty	PLASTIC AND RECONSTRUCTIVE SURGERY
	Primary medical specialty reported by the individual professional in the selected enrollment
Secondary Specialty 1	HAND SURGERY
	First secondary medical specialty reported by the individual professional in the selected enrollment
All Secondary Specialties	HAND SURGERY
	All four secondary specialties reported by the individual professional in the selected enrollment, separated by commas

Practice Information
Organization Legal Name	ILLINOIS DERMATOLOGY INSTITUTE LLC
	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	7911043054
	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	37
	Total number of individual professionals affiliated with the Group Practice based on Group Practice PAC ID
Line 1 Street Address	120 N OAK ST
	Group Practice or individual's line 1 address
City	HINSDALE
	Group Practice or individual's city
State	IL
	Group Practice or individual's state
Zip Code	605213829
	Group Practice or individual's zip code (9 digits when available)
Phone Number	6308569000
	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	140122
	Medicare CCN of hospital where individual professional provides service 1
Hospital Affiliation LBN 1	HINSDALE HOSPITAL
	Legal business name of hospital where individual professional provides service 1
Professional Accepts Medicare Assignment	Y