Physician Compare National (NPI:1457733438)

HEALTHCARE PROVIDER: CRAIG JAMES WILSON 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	1457733438
	Unique healthcare provider (clinician) ID assigned by NPPES
PECOS UID	9133423874
	Unique individual clinician ID assigned by PECOS
Professional Enrollment ID	I20200723000440
	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	CRAIG
	Individual professional first name
Provider Middle Name	J
	Individual professional middle name
Provider Gender	M
	The provider's gender if the provider is a person.

Medical School Information
Medical School Name	SOUTHERN ILLINOIS UNIVERSITY SCHOOL OF MEDICINE
	Individual professional's medical school
Graduation Year	2015
	Individual professional's medical school graduation year
Primary Specialty	ORTHOPEDIC SURGERY
	Primary medical specialty reported by the individual professional in the selected enrollment

Practice Information
Organization Legal Name	KNOX CLINIC CORP
	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	6305813411
	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	22
	Total number of individual professionals affiliated with the Group Practice based on Group Practice PAC ID
Line 1 Street Address	834 N SEMINARY ST
	Group Practice or individual's line 1 address
Line 2 Street Address	SUITE 102
	Group Practice or individual's line 2 address
City	GALESBURG
	Group Practice or individual's city
State	IL
	Group Practice or individual's state
Zip Code	614012897
	Group Practice or individual's zip code (9 digits when available)
Phone Number	3093420194
	Phone number is listed only when there is a single phone number available for the practice location address

Hospital(s) Affiliation Information
Professional Accepts Medicare Assignment	Y