Physician Compare National (NPI:1285642389)

HEALTHCARE PROVIDER: THOMAS JOHN WARDZALA AU.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	1285642389
	Unique healthcare provider (clinician) ID assigned by NPPES
PECOS UID	4587662044
	Unique individual clinician ID assigned by PECOS
Professional Enrollment ID	I20061116000152
	Unique ID for the individual professional enrollment that is the source for the data in the observation
Provider Last Name	WARDZALA
	Individual professional last name
Provider First Name	THOMAS
	Individual professional first name
Provider Middle Name	J
	Individual professional middle name
Provider Gender	M
	The provider's gender if the provider is a person.

Medical School Information
Medical School Name	AT STILL UNIVERSITY, ARIZONA SCHOOL OF DENTISTRY & ORAL HLTH
	Individual professional's medical school
Graduation Year	2009
	Individual professional's medical school graduation year
Primary Specialty	QUALIFIED AUDIOLOGIST
	Primary medical specialty reported by the individual professional in the selected enrollment

Practice Information
Organization Legal Name	ILLINOIS WISCONSIN SERTOMA REGIONAL CENTER FOR COMMUNICATIVE DISORDERS
	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	7315913977
	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	6
	Total number of individual professionals affiliated with the Group Practice based on Group Practice PAC ID
Line 1 Street Address	10409 S ROBERTS RD
	Group Practice or individual's line 1 address
City	PALOS HILLS
	Group Practice or individual's city
State	IL
	Group Practice or individual's state
Zip Code	604651931
	Group Practice or individual's zip code (9 digits when available)
Phone Number	7085999500
	Phone number is listed only when there is a single phone number available for the practice location address

Hospital(s) Affiliation Information
Professional Accepts Medicare Assignment	Y