Physician Compare National (NPI:1922193028)

HEALTHCARE PROVIDER: ERMIL WAGNER

Physician Compare National contains general information about individual eligible professionals (EPs) such as demographic information and Medicare quality program participation.

Individual Professional Information
NPI	1922193028
	Unique healthcare provider (clinician) ID assigned by NPPES
PECOS UID	3577645654
	Unique individual clinician ID assigned by PECOS
Professional Enrollment ID	I20080129000062
	Unique ID for the individual professional enrollment that is the source for the data in the observation
Provider Last Name	WAGNER
	Individual professional last name
Provider First Name	ERMIL
	Individual professional first name
Provider Gender	M
	The provider's gender if the provider is a person.

Medical School Information
Medical School Name	R FRANKLIN UNIVERSITY OF MED & SCI/CHICAGO MEDICAL SCHOOL
	Individual professional's medical school
Graduation Year	1988
	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
Organization Legal Name	MOHAMMAD WASEEM KAGZI MD LTD
	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	6406836998
	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	3
	Total number of individual professionals affiliated with the Group Practice based on Group Practice PAC ID
Line 1 Street Address	731S IL ROUTE 21 120
	Group Practice or individual's line 1 address
City	GURNEE
	Group Practice or individual's city
State	IL
	Group Practice or individual's state
Zip Code	600313803
	Group Practice or individual's zip code (9 digits when available)
Phone Number	8478559700
	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	140202
	Medicare CCN of hospital where individual professional provides service 1
Hospital Affiliation LBN 1	ADVOCATE CONDELL MEDICAL CENTER
	Legal business name of hospital where individual professional provides service 1
Hospital Affiliation CCN 2	140130
	Medicare CCN of hospital where individual professional provides service 2
Hospital Affiliation LBN 2	NORTHWESTERN LAKE FOREST HOSPITAL
	Legal business name of hospital where individual professional provides service 2
Professional Accepts Medicare Assignment	Y