Physician Compare National (NPI:1255486221)

HEALTHCARE PROVIDER: RICHARD ALPHONSO WILSON JR. 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	1255486221
	Unique healthcare provider (clinician) ID assigned by NPPES
PECOS UID	6002947165
	Unique individual clinician ID assigned by PECOS
Professional Enrollment ID	I20100706000651
	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	RICHARD
	Individual professional first name
Provider Middle Name	ALFONSO
	Individual professional middle name
Provider Name Suffix Text	JR.
	The name suffix of the provider if the provider is an individual. The name suffix is a ''generation-related'' suffix, such as Jr., Sr., II, III, IV, or V.
Provider Gender	M
	The provider's gender if the provider is a person.

Medical School Information
Medical School Name	HOWARD UNIVERSITY COLLEGE OF MEDICINE
	Individual professional's medical school
Graduation Year	1976
	Individual professional's medical school graduation year
Primary Specialty	INTERNAL MEDICINE
	Primary medical specialty reported by the individual professional in the selected enrollment
Secondary Specialty 1	RHEUMATOLOGY
	First secondary medical specialty reported by the individual professional in the selected enrollment
All Secondary Specialties	RHEUMATOLOGY
	All four secondary specialties reported by the individual professional in the selected enrollment, separated by commas

Practice Information
Line 1 Street Address	106 IRVING ST NW
	Group Practice or individual's line 1 address
Line 2 Street Address	SUITE 315
	Group Practice or individual's line 2 address
City	WASHINGTON
	Group Practice or individual's city
State	DC
	Group Practice or individual's state
Zip Code	200102993
	Group Practice or individual's zip code (9 digits when available)

Hospital(s) Affiliation Information
Hospital Affiliation CCN 1	090011
	Medicare CCN of hospital where individual professional provides service 1
Hospital Affiliation LBN 1	MEDSTAR WASHINGTON HOSPITAL CENTER
	Legal business name of hospital where individual professional provides service 1
Hospital Affiliation CCN 2	090005
	Medicare CCN of hospital where individual professional provides service 2
Hospital Affiliation LBN 2	SIBLEY MEMORIAL HOSPITAL
	Legal business name of hospital where individual professional provides service 2
Professional Accepts Medicare Assignment	Y