Physician Compare National (NPI:1831141654)

HEALTHCARE PROVIDER: JACK DEEMS GOLD 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	1831141654
	Unique healthcare provider (clinician) ID assigned by NPPES
PECOS UID	2062413172
	Unique individual clinician ID assigned by PECOS
Professional Enrollment ID	I20070116000328
	Unique ID for the individual professional enrollment that is the source for the data in the observation
Provider Last Name	GOLD
	Individual professional last name
Provider First Name	JACK
	Individual professional first name
Provider Middle Name	D
	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	1977
	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
Line 1 Street Address	15151 S US HWY 441
	Group Practice or individual's line 1 address
Line 2 Street Address	SUITE 300
	Group Practice or individual's line 2 address
City	SUMMERFIELD
	Group Practice or individual's city
State	FL
	Group Practice or individual's state
Zip Code	344914482
	Group Practice or individual's zip code (9 digits when available)
Phone Number	3525023525
	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