Physician Compare National (NPI:1992953749)

HEALTHCARE PROVIDER: JONATHAN ASHELY COLLIS JOHNSON 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	1992953749
	Unique healthcare provider (clinician) ID assigned by NPPES
PECOS UID	5597936856
	Unique individual clinician ID assigned by PECOS
Professional Enrollment ID	I20110916000035
	Unique ID for the individual professional enrollment that is the source for the data in the observation
Provider Last Name	JOHNSON
	Individual professional last name
Provider First Name	JONATHAN
	Individual professional first name
Provider Middle Name	A
	Individual professional middle name
Provider Gender	M
	The provider's gender if the provider is a person.

Medical School Information
Medical School Name	MEHARRY MEDICAL COLLEGE SCHOOL OF MEDICINE
	Individual professional's medical school
Graduation Year	2006
	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	3801 CANTERBURY RD
	Group Practice or individual's line 1 address
Line 2 Street Address	UNIT 711
	Group Practice or individual's line 2 address
City	BALTIMORE
	Group Practice or individual's city
State	MD
	Group Practice or individual's state
Zip Code	212182376
	Group Practice or individual's zip code (9 digits when available)

Hospital(s) Affiliation Information
Professional Accepts Medicare Assignment	Y