Physician Compare National (NPI:1538193131)

HEALTHCARE PROVIDER: KARL STEVEN 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	1538193131
	Unique healthcare provider (clinician) ID assigned by NPPES
PECOS UID	0840359188
	Unique individual clinician ID assigned by PECOS
Professional Enrollment ID	I20081031000464
	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	KARL
	Individual professional first name
Provider Middle Name	S
	Individual professional middle name
Provider Gender	M
	The provider's gender if the provider is a person.

Medical School Information
Medical School Name	VANDERBILT UNIVERSITY SCHOOL OF MEDICINE
	Individual professional's medical school
Graduation Year	1977
	Individual professional's medical school graduation year
Primary Specialty	OBSTETRICS/GYNECOLOGY
	Primary medical specialty reported by the individual professional in the selected enrollment

Practice Information
Line 1 Street Address	1500 WALTON BLVD
	Group Practice or individual's line 1 address
Line 2 Street Address	KARL STEVEN WAGNER MD PLLC
	Group Practice or individual's line 2 address
City	ROCHESTER
	Group Practice or individual's city
State	MI
	Group Practice or individual's state
Zip Code	483091858
	Group Practice or individual's zip code (9 digits when available)

Hospital(s) Affiliation Information
Hospital Affiliation CCN 1	230254
	Medicare CCN of hospital where individual professional provides service 1
Hospital Affiliation LBN 1	CRITTENTON HOSPITAL MEDICAL CENTER
	Legal business name of hospital where individual professional provides service 1
Hospital Affiliation CCN 2	230269
	Medicare CCN of hospital where individual professional provides service 2
Hospital Affiliation LBN 2	BEAUMONT HOSPITAL, TROY
	Legal business name of hospital where individual professional provides service 2
Professional Accepts Medicare Assignment	Y