Physician Compare National (NPI:1184933806)

HEALTHCARE PROVIDER: NICOLE M. WIRTZ PA-C

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

Individual Professional Information
NPI	1184933806
	Unique healthcare provider (clinician) ID assigned by NPPES
PECOS UID	6507052230
	Unique individual clinician ID assigned by PECOS
Professional Enrollment ID	I20101120000182
	Unique ID for the individual professional enrollment that is the source for the data in the observation
Provider Last Name	WIRTZ
	Individual professional last name
Provider First Name	NICOLE
	Individual professional first name
Provider Middle Name	M
	Individual professional middle name
Provider Gender	F
	The provider's gender if the provider is a person.

Medical School Information
Medical School Name	OTHER
	Individual professional's medical school
Graduation Year	2010
	Individual professional's medical school graduation year
Primary Specialty	PHYSICIAN ASSISTANT
	Primary medical specialty reported by the individual professional in the selected enrollment

Practice Information
Organization Legal Name	SPRINGFIELD CLINIC LLP
	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	0547166076
	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	558
	Total number of individual professionals affiliated with the Group Practice based on Group Practice PAC ID
Line 1 Street Address	775 ENGINEERING AVE
	Group Practice or individual's line 1 address
Marker of address line 2 suppression	Y
	Marker that address as reported may be incomplete
City	SPRINGFIELD
	Group Practice or individual's city
State	IL
	Group Practice or individual's state
Zip Code	627035909
	Group Practice or individual's zip code (9 digits when available)

Hospital(s) Affiliation Information
Hospital Affiliation CCN 1	141332
	Medicare CCN of hospital where individual professional provides service 1
Hospital Affiliation LBN 1	HILLSBORO AREA HOSPITAL
	Legal business name of hospital where individual professional provides service 1
Hospital Affiliation CCN 2	141339
	Medicare CCN of hospital where individual professional provides service 2
Hospital Affiliation LBN 2	TAYLORVILLE MEMORIAL HOSPITAL
	Legal business name of hospital where individual professional provides service 2
Professional Accepts Medicare Assignment	Y