Physician Compare National (NPI:1982140844)

HEALTHCARE PROVIDER: SIMON JACK GIBSON DNP, CRNA

Physician Compare National contains general information about individual eligible professionals (EPs) such as demographic information and Medicare quality program participation.

Individual Professional Information
NPI	1982140844
	Unique healthcare provider (clinician) ID assigned by NPPES
PECOS UID	4789969726
	Unique individual clinician ID assigned by PECOS
Professional Enrollment ID	I20170314001366
	Unique ID for the individual professional enrollment that is the source for the data in the observation
Provider Last Name	GIBSON
	Individual professional last name
Provider First Name	SIMON
	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	2016
	Individual professional's medical school graduation year
Primary Specialty	CERTIFIED REGISTERED NURSE ANESTHETIST (CRNA)
	Primary medical specialty reported by the individual professional in the selected enrollment

Practice Information
Organization Legal Name	AMERICAN ANESTHESIOLOGY OF TENNESSEE 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	9931001922
	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	462
	Total number of individual professionals affiliated with the Group Practice based on Group Practice PAC ID
Line 1 Street Address	501 20TH ST
	Group Practice or individual's line 1 address
Marker of address line 2 suppression	Y
	Marker that address as reported may be incomplete
City	KNOXVILLE
	Group Practice or individual's city
State	TN
	Group Practice or individual's state
Zip Code	379161863
	Group Practice or individual's zip code (9 digits when available)
Phone Number	8655468040
	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	440091
	Medicare CCN of hospital where individual professional provides service 1
Hospital Affiliation LBN 1	MEMORIAL HEALTHCARE SYSTEM, INC
	Legal business name of hospital where individual professional provides service 1
Hospital Affiliation CCN 2	440156
	Medicare CCN of hospital where individual professional provides service 2
Hospital Affiliation LBN 2	PARKRIDGE MEDICAL CENTER
	Legal business name of hospital where individual professional provides service 2
Professional Accepts Medicare Assignment	Y