Physician Compare National (NPI:1760450134)

HEALTHCARE PROVIDER: GLEN A WEISGERBER 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	1760450134
	Unique healthcare provider (clinician) ID assigned by NPPES
PECOS UID	5496949232
	Unique individual clinician ID assigned by PECOS
Professional Enrollment ID	I20101105000122
	Unique ID for the individual professional enrollment that is the source for the data in the observation
Provider Last Name	WEISGERBER
	Individual professional last name
Provider First Name	GLEN
	Individual professional first name
Provider Middle Name	A
	Individual professional middle name
Provider Gender	M
	The provider's gender if the provider is a person.

Medical School Information
Medical School Name	OTHER
	Individual professional's medical school
Graduation Year	1977
	Individual professional's medical school graduation year
Primary Specialty	FAMILY MEDICINE
	Primary medical specialty reported by the individual professional in the selected enrollment
Secondary Specialty 1	GENERAL PRACTICE
	First secondary medical specialty reported by the individual professional in the selected enrollment
All Secondary Specialties	GENERAL PRACTICE
	All four secondary specialties reported by the individual professional in the selected enrollment, separated by commas

Practice Information
Line 1 Street Address	100 S 5TH ST
	Group Practice or individual's line 1 address
City	AUBURN
	Group Practice or individual's city
State	IL
	Group Practice or individual's state
Zip Code	626151402
	Group Practice or individual's zip code (9 digits when available)

Hospital(s) Affiliation Information
Hospital Affiliation CCN 1	140148
	Medicare CCN of hospital where individual professional provides service 1
Hospital Affiliation LBN 1	MEMORIAL MEDICAL CENTER
	Legal business name of hospital where individual professional provides service 1
Hospital Affiliation CCN 2	140053
	Medicare CCN of hospital where individual professional provides service 2
Hospital Affiliation LBN 2	ST JOHNS HOSPITAL
	Legal business name of hospital where individual professional provides service 2
Professional Accepts Medicare Assignment	Y