Physician Compare National (NPI:1073507745)

HEALTHCARE PROVIDER: THOMAS P VAN DEN DRIESSCHE M.D.

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

Individual Professional Information
NPI	1073507745
	Unique healthcare provider (clinician) ID assigned by NPPES
PECOS UID	3678592292
	Unique individual clinician ID assigned by PECOS
Professional Enrollment ID	I20051114000365
	Unique ID for the individual professional enrollment that is the source for the data in the observation
Provider Last Name	VAN DEN DRIESSCHE
	Individual professional last name
Provider First Name	THOMAS
	Individual professional first name
Provider Middle Name	P
	Individual professional middle name
Provider Gender	M
	The provider's gender if the provider is a person.
Provider Credential Text	MD
	The abbreviations for professional degrees or credentials used or held by the provider, if the provider is an individual. Examples are MD, DDS, CSW, CNA, AA, NP, RNA, or PSY. These credential designations will not be verified by NPS.

Medical School Information
Medical School Name	INDIANA UNIVERSITY SCHOOL OF MEDICINE
	Individual professional's medical school
Graduation Year	1978
	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	3030 LAKE AVE
	Group Practice or individual's line 1 address
Line 2 Street Address	SUITE 32
	Group Practice or individual's line 2 address
City	FORT WAYNE
	Group Practice or individual's city
State	IN
	Group Practice or individual's state
Zip Code	468055428
	Group Practice or individual's zip code (9 digits when available)
Phone Number	2604243134
	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	150021
	Medicare CCN of hospital where individual professional provides service 1
Hospital Affiliation LBN 1	PARKVIEW REGIONAL MEDICAL CENTER
	Legal business name of hospital where individual professional provides service 1
Hospital Affiliation CCN 2	151300
	Medicare CCN of hospital where individual professional provides service 2
Hospital Affiliation LBN 2	COMMUNITY HOSPITAL OF BREMEN INC
	Legal business name of hospital where individual professional provides service 2
Hospital Affiliation CCN 3	150047
	Medicare CCN of hospital where individual professional provides service 3
Hospital Affiliation LBN 3	ST JOSEPH HOSPITAL
	Legal business name of hospital where individual professional provides service 3
Hospital Affiliation CCN 4	150017
	Medicare CCN of hospital where individual professional provides service 4
Hospital Affiliation LBN 4	LUTHERAN HOSPITAL OF INDIANA
	Legal business name of hospital where individual professional provides service 4
Hospital Affiliation CCN 5	150146
	Medicare CCN of hospital where individual professional provides service 5
Hospital Affiliation LBN 5	PARKVIEW NOBLE HOSPITAL
	Legal business name of hospital where individual professional provides service 5
Professional Accepts Medicare Assignment	Y

Physician Compare National (NPI:1073507745)

HEALTHCARE PROVIDER: THOMAS P VAN DEN DRIESSCHE M.D.

Individual Professional Information

Medical School Information

Practice Information

Hospital(s) Affiliation Information