Physician Compare National (NPI:1154338382)

HEALTHCARE PROVIDER: CHARLES S WILSON 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	1154338382
	Unique healthcare provider (clinician) ID assigned by NPPES
PECOS UID	6305031360
	Unique individual clinician ID assigned by PECOS
Professional Enrollment ID	I20101116000694
	Unique ID for the individual professional enrollment that is the source for the data in the observation
Provider Last Name	WILSON
	Individual professional last name
Provider First Name	CHARLES
	Individual professional first name
Provider Gender	M
	The provider's gender if the provider is a person.

Medical School Information
Medical School Name	VIRGINIA COMMONWEALTH UNIVERSITY, SCHOOL OF MEDICINE
	Individual professional's medical school
Graduation Year	1978
	Individual professional's medical school graduation year
Primary Specialty	OPHTHALMOLOGY
	Primary medical specialty reported by the individual professional in the selected enrollment

Practice Information
Line 1 Street Address	808 BUFFALO ST
	Group Practice or individual's line 1 address
City	FARMVILLE
	Group Practice or individual's city
State	VA
	Group Practice or individual's state
Zip Code	239011112
	Group Practice or individual's zip code (9 digits when available)
Phone Number	4343923375
	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	490090
	Medicare CCN of hospital where individual professional provides service 1
Hospital Affiliation LBN 1	CENTRA SOUTHSIDE COMMUNITY HOSPITAL, INC
	Legal business name of hospital where individual professional provides service 1
Hospital Affiliation CCN 2	490021
	Medicare CCN of hospital where individual professional provides service 2
Hospital Affiliation LBN 2	CENTRA
	Legal business name of hospital where individual professional provides service 2
Professional Accepts Medicare Assignment	Y