Physician Compare National (NPI:1891770178)

HEALTHCARE PROVIDER: ROBERT JACKSON SHERERTZ 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	1891770178
	Unique healthcare provider (clinician) ID assigned by NPPES
PECOS UID	1254228810
	Unique individual clinician ID assigned by PECOS
Professional Enrollment ID	I20120612000002
	Unique ID for the individual professional enrollment that is the source for the data in the observation
Provider Last Name	SHERERTZ
	Individual professional last name
Provider First Name	ROBERT
	Individual professional first name
Provider Middle Name	JACKSON
	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	UNIVERSITY OF VIRGINIA SCHOOL OF MEDICINE
	Individual professional's medical school
Graduation Year	1976
	Individual professional's medical school graduation year
Primary Specialty	INTERNAL MEDICINE
	Primary medical specialty reported by the individual professional in the selected enrollment
Secondary Specialty 1	INFECTIOUS DISEASE
	First secondary medical specialty reported by the individual professional in the selected enrollment
All Secondary Specialties	INFECTIOUS DISEASE
	All four secondary specialties reported by the individual professional in the selected enrollment, separated by commas

Practice Information
Organization Legal Name	SOUTHEASTERN HOSPITALIST SERVICES, 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	3476855420
	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	227
	Total number of individual professionals affiliated with the Group Practice based on Group Practice PAC ID
Line 1 Street Address	809 82ND PKWY
	Group Practice or individual's line 1 address
City	MYRTLE BEACH
	Group Practice or individual's city
State	SC
	Group Practice or individual's state
Zip Code	295724607
	Group Practice or individual's zip code (9 digits when available)
Phone Number	8436921000
	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	420085
	Medicare CCN of hospital where individual professional provides service 1
Hospital Affiliation LBN 1	GRAND STRAND REGIONAL MEDICAL CENTER
	Legal business name of hospital where individual professional provides service 1
Professional Accepts Medicare Assignment	Y