Physician Compare National (NPI:1295710564)

HEALTHCARE PROVIDER: DONALD W WAGNON 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	1295710564
	Unique healthcare provider (clinician) ID assigned by NPPES
PECOS UID	7012995954
	Unique individual clinician ID assigned by PECOS
Professional Enrollment ID	I20101118000897
	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	DONALD
	Individual professional first name
Provider Middle Name	W
	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	SAINT LOUIS UNIVERSITY SCHOOL OF MEDICINE
	Individual professional's medical school
Graduation Year	1990
	Individual professional's medical school graduation year
Primary Specialty	DIAGNOSTIC RADIOLOGY
	Primary medical specialty reported by the individual professional in the selected enrollment

Practice Information
Organization Legal Name	SPRINGHILL DIAGNOSTIC RADIOLOGISTS, P.C.
	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	0042298978
	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	6
	Total number of individual professionals affiliated with the Group Practice based on Group Practice PAC ID
Line 1 Street Address	3719 DAUPHIN ST
	Group Practice or individual's line 1 address
City	MOBILE
	Group Practice or individual's city
State	AL
	Group Practice or individual's state
Zip Code	366081753
	Group Practice or individual's zip code (9 digits when available)
Phone Number	2514713921
	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	010144
	Medicare CCN of hospital where individual professional provides service 1
Hospital Affiliation LBN 1	SPRINGHILL MEDICAL CENTER
	Legal business name of hospital where individual professional provides service 1
Professional Accepts Medicare Assignment	Y