Physician Compare National (NPI:1548243678)

HEALTHCARE PROVIDER: JOHN R WILSON 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	1548243678
	Unique healthcare provider (clinician) ID assigned by NPPES
PECOS UID	3971542911
	Unique individual clinician ID assigned by PECOS
Professional Enrollment ID	I20050428000572
	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	JOHN
	Individual professional first name
Provider Middle Name	R
	Individual professional middle name
Provider Gender	M
	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	WASHINGTON UNIVERSITY SCHOOL OF MEDICINE
	Individual professional's medical school
Graduation Year	1988
	Individual professional's medical school graduation year
Primary Specialty	NEUROLOGY
	Primary medical specialty reported by the individual professional in the selected enrollment
Secondary Specialty 1	INTERNAL MEDICINE
	First secondary medical specialty reported by the individual professional in the selected enrollment
All Secondary Specialties	INTERNAL MEDICINE
	All four secondary specialties reported by the individual professional in the selected enrollment, separated by commas

Practice Information
Line 1 Street Address	675 W N AVE
	Group Practice or individual's line 1 address
Line 2 Street Address	SUITE 608
	Group Practice or individual's line 2 address
City	MELROSE PARK
	Group Practice or individual's city
State	IL
	Group Practice or individual's state
Zip Code	601601627
	Group Practice or individual's zip code (9 digits when available)

Hospital(s) Affiliation Information
Hospital Affiliation CCN 1	140008
	Medicare CCN of hospital where individual professional provides service 1
Hospital Affiliation LBN 1	GOTTLIEB MEMORIAL HOSPITAL
	Legal business name of hospital where individual professional provides service 1
Hospital Affiliation CCN 2	140049
	Medicare CCN of hospital where individual professional provides service 2
Hospital Affiliation LBN 2	WEST SUBURBAN MEDICAL CENTER
	Legal business name of hospital where individual professional provides service 2
Hospital Affiliation CCN 3	140117
	Medicare CCN of hospital where individual professional provides service 3
Hospital Affiliation LBN 3	PRESENCE RESURRECTION MEDICAL CENTER
	Legal business name of hospital where individual professional provides service 3
Hospital Affiliation CCN 4	140200
	Medicare CCN of hospital where individual professional provides service 4
Hospital Affiliation LBN 4	ELMHURST MEMORIAL HOSPITAL
	Legal business name of hospital where individual professional provides service 4
Hospital Affiliation CCN 5	140083
	Medicare CCN of hospital where individual professional provides service 5
Hospital Affiliation LBN 5	LORETTO HOSPITAL
	Legal business name of hospital where individual professional provides service 5
Professional Accepts Medicare Assignment	Y

Physician Compare National (NPI:1548243678)

HEALTHCARE PROVIDER: JOHN R WILSON MD

Individual Professional Information

Medical School Information

Practice Information

Hospital(s) Affiliation Information