Physician Compare National (NPI:1174727093)

HEALTHCARE PROVIDER: THOMAS EDWARD DUDLEY 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	1174727093
	Unique healthcare provider (clinician) ID assigned by NPPES
PECOS UID	6002908068
	Unique individual clinician ID assigned by PECOS
Professional Enrollment ID	I20070822000654
	Unique ID for the individual professional enrollment that is the source for the data in the observation
Provider Last Name	DUDLEY
	Individual professional last name
Provider First Name	THOMAS
	Individual professional first name
Provider Middle Name	E
	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	2007
	Individual professional's medical school graduation year
Primary Specialty	ORTHOPEDIC SURGERY
	Primary medical specialty reported by the individual professional in the selected enrollment

Practice Information
Organization Legal Name	DOUGLAS COUNTY HOSPITAL
	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	0648171413
	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	95
	Total number of individual professionals affiliated with the Group Practice based on Group Practice PAC ID
Line 1 Street Address	111 17TH AVE E
	Group Practice or individual's line 1 address
Line 2 Street Address	SUITE 101
	Group Practice or individual's line 2 address
City	ALEXANDRIA
	Group Practice or individual's city
State	MN
	Group Practice or individual's state
Zip Code	563083734
	Group Practice or individual's zip code (9 digits when available)
Phone Number	3207621144
	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	240030
	Medicare CCN of hospital where individual professional provides service 1
Hospital Affiliation LBN 1	DOUGLAS COUNTY HOSPITAL
	Legal business name of hospital where individual professional provides service 1
Hospital Affiliation CCN 2	240088
	Medicare CCN of hospital where individual professional provides service 2
Hospital Affiliation LBN 2	CARRIS HEALTH LLC
	Legal business name of hospital where individual professional provides service 2
Hospital Affiliation CCN 3	241343
	Medicare CCN of hospital where individual professional provides service 3
Hospital Affiliation LBN 3	MUNICIPAL HOSPITAL AND GRANITE MANOR
	Legal business name of hospital where individual professional provides service 3
Hospital Affiliation CCN 4	241379
	Medicare CCN of hospital where individual professional provides service 4
Hospital Affiliation LBN 4	PRAIRIE RIDGE HOSPITAL AND HEALTH SERVICES
	Legal business name of hospital where individual professional provides service 4
Professional Accepts Medicare Assignment	Y