Physician Compare National (NPI:1073803391)

HEALTHCARE PROVIDER: RYAN BERG 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	1073803391
	Unique healthcare provider (clinician) ID assigned by NPPES
PECOS UID	1052630589
	Unique individual clinician ID assigned by PECOS
Professional Enrollment ID	I20160706000290
	Unique ID for the individual professional enrollment that is the source for the data in the observation
Provider Last Name	BERG
	Individual professional last name
Provider First Name	RYAN
	Individual professional first name
Provider Middle Name	W
	Individual professional middle name
Provider Gender	M
	The provider's gender if the provider is a person.

Medical School Information
Medical School Name	UNIVERSITY OF WISCONSIN SCHOOL OF MEDICINE
	Individual professional's medical school
Graduation Year	2011
	Individual professional's medical school graduation year
Primary Specialty	GENERAL SURGERY
	Primary medical specialty reported by the individual professional in the selected enrollment
Secondary Specialty 1	VASCULAR SURGERY
	First secondary medical specialty reported by the individual professional in the selected enrollment
All Secondary Specialties	VASCULAR SURGERY
	All four secondary specialties reported by the individual professional in the selected enrollment, separated by commas

Practice Information
Organization Legal Name	WHEATON FRANCISCAN MEDICAL GROUP INC
	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	8628980943
	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	609
	Total number of individual professionals affiliated with the Group Practice based on Group Practice PAC ID
Line 1 Street Address	3070 N 51ST ST
	Group Practice or individual's line 1 address
Line 2 Street Address	SUITE 601
	Group Practice or individual's line 2 address
City	MILWAUKEE
	Group Practice or individual's city
State	WI
	Group Practice or individual's state
Zip Code	532101663
	Group Practice or individual's zip code (9 digits when available)
Phone Number	4143025404
	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	520136
	Medicare CCN of hospital where individual professional provides service 1
Hospital Affiliation LBN 1	WHEATON FRANCISCAN ST JOSEPH
	Legal business name of hospital where individual professional provides service 1
Professional Accepts Medicare Assignment	Y