Physician Compare National (NPI:1538152400)

HEALTHCARE PROVIDER: DIANA ELIZABETH 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	1538152400
	Unique healthcare provider (clinician) ID assigned by NPPES
PECOS UID	2860393865
	Unique individual clinician ID assigned by PECOS
Professional Enrollment ID	I20040114000121
	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	DIANA
	Individual professional first name
Provider Middle Name	ELIZABETH
	Individual professional middle name
Provider Gender	F
	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	UNIVERSITY OF TEXAS MEDICAL SCHOOL AT HOUSTON
	Individual professional's medical school
Graduation Year	1985
	Individual professional's medical school graduation year
Primary Specialty	NEUROSURGERY
	Primary medical specialty reported by the individual professional in the selected enrollment

Practice Information
Line 1 Street Address	1001 12TH AVE
	Group Practice or individual's line 1 address
Line 2 Street Address	SUITE 171
	Group Practice or individual's line 2 address
City	FT WORTH
	Group Practice or individual's city
State	TX
	Group Practice or individual's state
Zip Code	761043926
	Group Practice or individual's zip code (9 digits when available)

Hospital(s) Affiliation Information
Hospital Affiliation CCN 1	450137
	Medicare CCN of hospital where individual professional provides service 1
Hospital Affiliation LBN 1	BAYLOR SCOTT & WHITE ALL SAINTS MEDICAL CENTER FORT WORTH
	Legal business name of hospital where individual professional provides service 1
Hospital Affiliation CCN 2	450672
	Medicare CCN of hospital where individual professional provides service 2
Hospital Affiliation LBN 2	MEDICAL CITY FORT WORTH
	Legal business name of hospital where individual professional provides service 2
Hospital Affiliation CCN 3	450135
	Medicare CCN of hospital where individual professional provides service 3
Hospital Affiliation LBN 3	TEXAS HEALTH HARRIS METHODIST HOSPITAL FORT WORTH
	Legal business name of hospital where individual professional provides service 3
Professional Accepts Medicare Assignment	Y