Physician Compare National (NPI:1609072933)

HEALTHCARE PROVIDER: MELANIE JANETTE WAHL 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	1609072933
	Unique healthcare provider (clinician) ID assigned by NPPES
PECOS UID	4385790765
	Unique individual clinician ID assigned by PECOS
Professional Enrollment ID	I20200604000355
	Unique ID for the individual professional enrollment that is the source for the data in the observation
Provider Last Name	WAHL
	Individual professional last name
Provider First Name	MELANIE
	Individual professional first name
Provider Middle Name	JANETTE
	Individual professional middle name
Provider Gender	F
	The provider's gender if the provider is a person.

Medical School Information
Medical School Name	OTHER
	Individual professional's medical school
Graduation Year	2006
	Individual professional's medical school graduation year
Primary Specialty	RHEUMATOLOGY
	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
Organization Legal Name	SPARTA COMMUNITY HOSPITAL DBA QUALITY HEALTHCARE CLINICS
	Legal name of the Group Practice that the individual professional works with- will be blank if the address is not linked to a Group Practice
Group Practice PAC ID	6709870462
	Unique Group Practice ID assigned by PECOS to the Group Practice that the individual professional works with- will be blank if the address is not linked to a Group Practice
Number of Group Practice members	34
	Total number of individual professionals affiliated with the Group Practice based on Group Practice PAC ID
Line 1 Street Address	1300 N MARKET ST
	Group Practice or individual's line 1 address
City	SPARTA
	Group Practice or individual's city
State	IL
	Group Practice or individual's state
Zip Code	622861048
	Group Practice or individual's zip code (9 digits when available)
Phone Number	6184434138
	Phone number is listed only when there is a single phone number available for the practice location address

Hospital(s) Affiliation Information
Hospital Affiliation CCN 1	260081
	Medicare CCN of hospital where individual professional provides service 1
Hospital Affiliation LBN 1	SSM ST CLARE HEALTH CENTER
	Legal business name of hospital where individual professional provides service 1
Hospital Affiliation CCN 2	141349
	Medicare CCN of hospital where individual professional provides service 2
Hospital Affiliation LBN 2	SPARTA COMMUNITY HOSPITAL
	Legal business name of hospital where individual professional provides service 2
Professional Accepts Medicare Assignment	Y