Physician Compare National (NPI:1245440841)

HEALTHCARE PROVIDER: PETER WAGNER MD

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

Individual Professional Information
NPI	1245440841
	Unique healthcare provider (clinician) ID assigned by NPPES
PECOS UID	0446343784
	Unique individual clinician ID assigned by PECOS
Professional Enrollment ID	I20110511000801
	Unique ID for the individual professional enrollment that is the source for the data in the observation
Provider Last Name	WAGNER
	Individual professional last name
Provider First Name	PETER
	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	1992
	Individual professional's medical school graduation year
Primary Specialty	HEMATOLOGY/ONCOLOGY
	Primary medical specialty reported by the individual professional in the selected enrollment

Practice Information
Organization Legal Name	KALISPELL REGIONAL MEDICAL CENTER 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	5294644381
	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	243
	Total number of individual professionals affiliated with the Group Practice based on Group Practice PAC ID
Line 1 Street Address	350 HERITAGE WAY
	Group Practice or individual's line 1 address
Line 2 Street Address	1100 NORTHWEST MT SURGICAL ASSOCIATES
	Group Practice or individual's line 2 address
City	KALISPELL
	Group Practice or individual's city
State	MT
	Group Practice or individual's state
Zip Code	599013158
	Group Practice or individual's zip code (9 digits when available)
Phone Number	4067566927
	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	270051
	Medicare CCN of hospital where individual professional provides service 1
Hospital Affiliation LBN 1	KALISPELL REGIONAL MEDICAL CENTER
	Legal business name of hospital where individual professional provides service 1
Hospital Affiliation CCN 2	270087
	Medicare CCN of hospital where individual professional provides service 2
Hospital Affiliation LBN 2	THE HEALTHCENTER
	Legal business name of hospital where individual professional provides service 2
Hospital Affiliation CCN 3	271320
	Medicare CCN of hospital where individual professional provides service 3
Hospital Affiliation LBN 3	CABINET PEAKS MEDICAL CENTER
	Legal business name of hospital where individual professional provides service 3
Hospital Affiliation CCN 4	271336
	Medicare CCN of hospital where individual professional provides service 4
Hospital Affiliation LBN 4	NORTH VALLEY HOSPITAL
	Legal business name of hospital where individual professional provides service 4
Hospital Affiliation CCN 5	271343
	Medicare CCN of hospital where individual professional provides service 5
Hospital Affiliation LBN 5	PROVIDENCE ST JOSEPH MEDICAL CENTER
	Legal business name of hospital where individual professional provides service 5
Professional Accepts Medicare Assignment	Y

Physician Compare National (NPI:1245440841)

HEALTHCARE PROVIDER: PETER WAGNER MD

Individual Professional Information

Medical School Information

Practice Information

Hospital(s) Affiliation Information