Physician Compare National (NPI:1841315678)

HEALTHCARE PROVIDER: WILLIE L WELLS 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	1841315678
	Unique healthcare provider (clinician) ID assigned by NPPES
PECOS UID	1850468976
	Unique individual clinician ID assigned by PECOS
Professional Enrollment ID	I20080916000077
	Unique ID for the individual professional enrollment that is the source for the data in the observation
Provider Last Name	WELLS
	Individual professional last name
Provider First Name	WILLIE
	Individual professional first name
Provider Middle Name	LEE
	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 MISSISSIPPI SCHOOL OF MEDICINE
	Individual professional's medical school
Graduation Year	1981
	Individual professional's medical school graduation year
Primary Specialty	FAMILY MEDICINE
	Primary medical specialty reported by the individual professional in the selected enrollment

Practice Information
Line 1 Street Address	407 E CALHOUN ST
	Group Practice or individual's line 1 address
City	BRUCE
	Group Practice or individual's city
State	MS
	Group Practice or individual's state
Zip Code	389150902
	Group Practice or individual's zip code (9 digits when available)

Hospital(s) Affiliation Information
Hospital Affiliation CCN 1	251331
	Medicare CCN of hospital where individual professional provides service 1
Hospital Affiliation LBN 1	BMH-CALHOUN
	Legal business name of hospital where individual professional provides service 1
Hospital Affiliation CCN 2	250017
	Medicare CCN of hospital where individual professional provides service 2
Hospital Affiliation LBN 2	TRACE REGIONAL HOSP AND SWING BED
	Legal business name of hospital where individual professional provides service 2
Hospital Affiliation CCN 3	250034
	Medicare CCN of hospital where individual professional provides service 3
Hospital Affiliation LBN 3	BAPTIST MEMORIAL HOSPITAL NORTH MS
	Legal business name of hospital where individual professional provides service 3
Hospital Affiliation CCN 4	251308
	Medicare CCN of hospital where individual professional provides service 4
Hospital Affiliation LBN 4	PONTOTOC HEALTH SERVICE INC CAH
	Legal business name of hospital where individual professional provides service 4
Hospital Affiliation CCN 5	250044
	Medicare CCN of hospital where individual professional provides service 5
Hospital Affiliation LBN 5	BAPTIST MEMORIAL HOSPITAL BOONEVILLE
	Legal business name of hospital where individual professional provides service 5
Professional Accepts Medicare Assignment	Y

Physician Compare National (NPI:1841315678)

HEALTHCARE PROVIDER: WILLIE L WELLS MD

Individual Professional Information

Medical School Information

Practice Information

Hospital(s) Affiliation Information