Physician Compare National (NPI:1790164234)

HEALTHCARE PROVIDER: JERRY ANDERSON PH.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	1790164234
	Unique healthcare provider (clinician) ID assigned by NPPES
PECOS UID	1850608001
	Unique individual clinician ID assigned by PECOS
Professional Enrollment ID	I20150921001140
	Unique ID for the individual professional enrollment that is the source for the data in the observation
Provider Last Name	ANDERSON
	Individual professional last name
Provider First Name	JERRY
	Individual professional first 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	2002
	Individual professional's medical school graduation year
Primary Specialty	PSYCHOLOGIST, CLINICAL
	Primary medical specialty reported by the individual professional in the selected enrollment

Practice Information
Organization Legal Name	VERICARE PC
	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	1850204983
	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	24
	Total number of individual professionals affiliated with the Group Practice based on Group Practice PAC ID
Line 1 Street Address	4905 FLEMING ST
	Group Practice or individual's line 1 address
Line 2 Street Address	BAYOU PINES CARE CENTER
	Group Practice or individual's line 2 address
City	LA MARQUE
	Group Practice or individual's city
State	TX
	Group Practice or individual's state
Zip Code	775683049
	Group Practice or individual's zip code (9 digits when available)
Phone Number	8002578715
	Phone number is listed only when there is a single phone number available for the practice location address

Hospital(s) Affiliation Information
Professional Accepts Medicare Assignment	Y