Physician Compare National (NPI:1285722819)

HEALTHCARE PROVIDER: ANDREW STEPHEN 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	1285722819
	Unique healthcare provider (clinician) ID assigned by NPPES
PECOS UID	8527077841
	Unique individual clinician ID assigned by PECOS
Professional Enrollment ID	I20060414000064
	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	ANDREW
	Individual professional first name
Provider Middle Name	STEPHEN
	Individual professional middle name
Provider Gender	M
	The provider's gender if the provider is a person.
Provider Credential Text	MD
	The abbreviations for professional degrees or credentials used or held by the provider, if the provider is an individual. Examples are MD, DDS, CSW, CNA, AA, NP, RNA, or PSY. These credential designations will not be verified by NPS.

Medical School Information
Medical School Name	UN OF CALIFORNIA, IRVINE, COLLEGE OF MEDICINE
	Individual professional's medical school
Graduation Year	1982
	Individual professional's medical school graduation year
Primary Specialty	FAMILY MEDICINE
	Primary medical specialty reported by the individual professional in the selected enrollment
Secondary Specialty 1	HOSPICE/PALLIATIVE CARE
	First secondary medical specialty reported by the individual professional in the selected enrollment
All Secondary Specialties	HOSPICE/PALLIATIVE CARE
	All four secondary specialties reported by the individual professional in the selected enrollment, separated by commas

Practice Information
Line 1 Street Address	819 LONGWOOD LN
	Group Practice or individual's line 1 address
City	SEBASTOPOL
	Group Practice or individual's city
State	CA
	Group Practice or individual's state
Zip Code	954722734
	Group Practice or individual's zip code (9 digits when available)
Phone Number	7078276320
	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	050174
	Medicare CCN of hospital where individual professional provides service 1
Hospital Affiliation LBN 1	SANTA ROSA MEMORIAL HOSPITAL
	Legal business name of hospital where individual professional provides service 1
Professional Accepts Medicare Assignment	Y