Physician Compare National (NPI:1295821569)

HEALTHCARE PROVIDER: DANIEL DAVID OPHEIM 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	1295821569
	Unique healthcare provider (clinician) ID assigned by NPPES
PECOS UID	9638327166
	Unique individual clinician ID assigned by PECOS
Professional Enrollment ID	I20200723001296
	Unique ID for the individual professional enrollment that is the source for the data in the observation
Provider Last Name	OPHEIM
	Individual professional last name
Provider First Name	DANIEL
	Individual professional first 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	2006
	Individual professional's medical school graduation year
Primary Specialty	COLORECTAL SURGERY (PROCTOLOGY)
	Primary medical specialty reported by the individual professional in the selected enrollment

Practice Information
Organization Legal Name	EAST TENNESSEE COLON AND RECTAL SURGICAL ASSOCIATES PC
	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	5092864025
	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	10810 PARKSIDE DR
	Group Practice or individual's line 1 address
Line 2 Street Address	SUITE 201
	Group Practice or individual's line 2 address
City	KNOXVILLE
	Group Practice or individual's city
State	TN
	Group Practice or individual's state
Zip Code	379341983
	Group Practice or individual's zip code (9 digits when available)
Phone Number	8653929220230
	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	240047
	Medicare CCN of hospital where individual professional provides service 1
Hospital Affiliation LBN 1	ST LUKES HOSPITAL
	Legal business name of hospital where individual professional provides service 1
Professional Accepts Medicare Assignment	Y