Physician Compare National (NPI:1265623268)

HEALTHCARE PROVIDER: JON ANTHONY WAGNON D.O.

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

Individual Professional Information
NPI	1265623268
	Unique healthcare provider (clinician) ID assigned by NPPES
PECOS UID	0345300596
	Unique individual clinician ID assigned by PECOS
Professional Enrollment ID	I20081118000860
	Unique ID for the individual professional enrollment that is the source for the data in the observation
Provider Last Name	WAGNON
	Individual professional last name
Provider First Name	JON
	Individual professional first name
Provider Middle Name	ANTHONY
	Individual professional middle 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	2005
	Individual professional's medical school graduation year
Primary Specialty	OSTEOPATHIC MANIPULATIVE MEDICINE
	Primary medical specialty reported by the individual professional in the selected enrollment
Secondary Specialty 1	INTERNAL MEDICINE
	First secondary medical specialty reported by the individual professional in the selected enrollment
All Secondary Specialties	INTERNAL MEDICINE
	All four secondary specialties reported by the individual professional in the selected enrollment, separated by commas

Practice Information
Line 1 Street Address	1368 DADRIAN PROFESSIONAL PARK
	Group Practice or individual's line 1 address
City	GODFREY
	Group Practice or individual's city
State	IL
	Group Practice or individual's state
Zip Code	620351685
	Group Practice or individual's zip code (9 digits when available)

Hospital(s) Affiliation Information
Hospital Affiliation CCN 1	141350
	Medicare CCN of hospital where individual professional provides service 1
Hospital Affiliation LBN 1	ST FRANCIS HOSPITAL
	Legal business name of hospital where individual professional provides service 1
Hospital Affiliation CCN 2	140002
	Medicare CCN of hospital where individual professional provides service 2
Hospital Affiliation LBN 2	ALTON MEMORIAL HOSPITAL
	Legal business name of hospital where individual professional provides service 2
Hospital Affiliation CCN 3	140052
	Medicare CCN of hospital where individual professional provides service 3
Hospital Affiliation LBN 3	OSF SAINT ANTHONY'S HEALTH CENTER
	Legal business name of hospital where individual professional provides service 3
Professional Accepts Medicare Assignment	Y