Physician Compare National (NPI:1548265051)

HEALTHCARE PROVIDER: GARY MASON WILKES 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	1548265051
	Unique healthcare provider (clinician) ID assigned by NPPES
PECOS UID	4486745932
	Unique individual clinician ID assigned by PECOS
Professional Enrollment ID	I20070813000304
	Unique ID for the individual professional enrollment that is the source for the data in the observation
Provider Last Name	WILKES
	Individual professional last name
Provider First Name	GARY
	Individual professional first name
Provider Middle Name	M
	Individual professional middle name
Provider Gender	M
	The provider's gender if the provider is a person.

Medical School Information
Medical School Name	UNIVERSITY OF CINCINNATI COLLEGE OF MEDICINE
	Individual professional's medical school
Graduation Year	1981
	Individual professional's medical school graduation year
Primary Specialty	PSYCHIATRY
	Primary medical specialty reported by the individual professional in the selected enrollment

Practice Information
Line 1 Street Address	23811 CHAGRIN BLVD
	Group Practice or individual's line 1 address
Line 2 Street Address	SUITE 170
	Group Practice or individual's line 2 address
City	BEACHWOOD
	Group Practice or individual's city
State	OH
	Group Practice or individual's state
Zip Code	441225525
	Group Practice or individual's zip code (9 digits when available)

Hospital(s) Affiliation Information
Hospital Affiliation CCN 1	360144
	Medicare CCN of hospital where individual professional provides service 1
Hospital Affiliation LBN 1	SOUTH POINTE HOSPITAL
	Legal business name of hospital where individual professional provides service 1
Hospital Affiliation CCN 2	360143
	Medicare CCN of hospital where individual professional provides service 2
Hospital Affiliation LBN 2	MARYMOUNT HOSPITAL
	Legal business name of hospital where individual professional provides service 2
Professional Accepts Medicare Assignment	Y