Physician Compare National (NPI:1912104159)

HEALTHCARE PROVIDER: HURSIE J DAVIS-SULLIVAN M.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	1912104159
	Unique healthcare provider (clinician) ID assigned by NPPES
PECOS UID	0042404006
	Unique individual clinician ID assigned by PECOS
Professional Enrollment ID	I20101103001037
	Unique ID for the individual professional enrollment that is the source for the data in the observation
Provider Last Name	DAVIS-SULLIVAN
	Individual professional last name
Provider First Name	HURSIE
	Individual professional first name
Provider Middle Name	JEAN
	Individual professional middle name
Provider Gender	F
	The provider's gender if the provider is a person.

Medical School Information
Medical School Name	UNIVERSITY OF IOWA, RJ & L CARVER COLLEGE OF MEDICINE
	Individual professional's medical school
Graduation Year	1993
	Individual professional's medical school graduation year
Primary Specialty	FAMILY MEDICINE
	Primary medical specialty reported by the individual professional in the selected enrollment

Practice Information
Line 1 Street Address	1814 HOSPITAL DR
	Group Practice or individual's line 1 address
City	JACKSON
	Group Practice or individual's city
State	MS
	Group Practice or individual's state
Zip Code	392043410
	Group Practice or individual's zip code (9 digits when available)

Hospital(s) Affiliation Information
Hospital Affiliation CCN 1	250072
	Medicare CCN of hospital where individual professional provides service 1
Hospital Affiliation LBN 1	MERIT HEALTH CENTRAL
	Legal business name of hospital where individual professional provides service 1
Professional Accepts Medicare Assignment	Y