Physician Compare National (NPI:1063434637)

HEALTHCARE PROVIDER: STEVEN B THOM 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	1063434637
	Unique healthcare provider (clinician) ID assigned by NPPES
PECOS UID	7113005125
	Unique individual clinician ID assigned by PECOS
Professional Enrollment ID	I20090101000003
	Unique ID for the individual professional enrollment that is the source for the data in the observation
Provider Last Name	THOM
	Individual professional last name
Provider First Name	STEVEN
	Individual professional first name
Provider Middle Name	B
	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 MINNESOTA MEDICAL SCHOOL
	Individual professional's medical school
Graduation Year	1993
	Individual professional's medical school graduation year
Primary Specialty	OPHTHALMOLOGY
	Primary medical specialty reported by the individual professional in the selected enrollment

Practice Information
Line 1 Street Address	2601 UNIVERSITY DR S
	Group Practice or individual's line 1 address
City	FARGO
	Group Practice or individual's city
State	ND
	Group Practice or individual's state
Zip Code	581036025
	Group Practice or individual's zip code (9 digits when available)

Hospital(s) Affiliation Information
Hospital Affiliation CCN 1	240052
	Medicare CCN of hospital where individual professional provides service 1
Hospital Affiliation LBN 1	LAKE REGION HEALTHCARE CORPORATION
	Legal business name of hospital where individual professional provides service 1
Professional Accepts Medicare Assignment	Y