Physician Compare National (NPI:1528175841)

HEALTHCARE PROVIDER: GARY ROYCE WISNER 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	1528175841
	Unique healthcare provider (clinician) ID assigned by NPPES
PECOS UID	7214027333
	Unique individual clinician ID assigned by PECOS
Professional Enrollment ID	I20071213000203
	Unique ID for the individual professional enrollment that is the source for the data in the observation
Provider Last Name	WISNER
	Individual professional last name
Provider First Name	GARY
	Individual professional first name
Provider Middle Name	ROYCE
	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	1982
	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
Line 1 Street Address	621 S HAM LN A
	Group Practice or individual's line 1 address
City	LODI
	Group Practice or individual's city
State	CA
	Group Practice or individual's state
Zip Code	952423533
	Group Practice or individual's zip code (9 digits when available)

Hospital(s) Affiliation Information
Hospital Affiliation CCN 1	050336
	Medicare CCN of hospital where individual professional provides service 1
Hospital Affiliation LBN 1	ADVENTIST HEALTH LODI MEMORIAL
	Legal business name of hospital where individual professional provides service 1
Hospital Affiliation CCN 2	050557
	Medicare CCN of hospital where individual professional provides service 2
Hospital Affiliation LBN 2	MEMORIAL MEDICAL CENTER
	Legal business name of hospital where individual professional provides service 2
Professional Accepts Medicare Assignment	Y