Physician Compare National (NPI:1831208768)

HEALTHCARE PROVIDER: CARL E. JACKSON 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	1831208768
	Unique healthcare provider (clinician) ID assigned by NPPES
PECOS UID	4082713631
	Unique individual clinician ID assigned by PECOS
Professional Enrollment ID	I20070621000577
	Unique ID for the individual professional enrollment that is the source for the data in the observation
Provider Last Name	JACKSON
	Individual professional last name
Provider First Name	CARL
	Individual professional first name
Provider Middle Name	E
	Individual professional middle name
Provider Gender	M
	The provider's gender if the provider is a person.
Provider Credential Text	MD
	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.

Medical School Information
Medical School Name	HOWARD UNIVERSITY COLLEGE OF MEDICINE
	Individual professional's medical school
Graduation Year	1987
	Individual professional's medical school graduation year
Primary Specialty	GENERAL SURGERY
	Primary medical specialty reported by the individual professional in the selected enrollment

Practice Information
Line 1 Street Address	20050 HARVARD AVE
	Group Practice or individual's line 1 address
Line 2 Street Address	SUITE 205
	Group Practice or individual's line 2 address
City	WARRENSVILLE HEIGHTS
	Group Practice or individual's city
State	OH
	Group Practice or individual's state
Zip Code	441226800
	Group Practice or individual's zip code (9 digits when available)

Hospital(s) Affiliation Information
Hospital Affiliation CCN 1	360144
	Medicare CCN of hospital where individual professional provides service 1
Hospital Affiliation LBN 1	SOUTH POINTE HOSPITAL
	Legal business name of hospital where individual professional provides service 1
Professional Accepts Medicare Assignment	Y