Physician Compare National (NPI:1306853981)

HEALTHCARE PROVIDER:

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

Individual Professional Information
NPI	1306853981
	Unique healthcare provider (clinician) ID assigned by NPPES
PECOS UID	7810023603
	Unique individual clinician ID assigned by PECOS
Professional Enrollment ID	I20100331000680
	Unique ID for the individual professional enrollment that is the source for the data in the observation
Provider Last Name	HOFFMAN
	Individual professional last name
Provider First Name	DANIEL
	Individual professional first name
Provider Middle Name	R
	Individual professional middle name
Provider Gender	M
	The provider's gender if the provider is a person.

Medical School Information
Medical School Name	COLLEGE OF MEDICINE AND SURGERY
	Individual professional's medical school
Graduation Year	1978
	Individual professional's medical school graduation year
Primary Specialty	GENERAL PRACTICE
	Primary medical specialty reported by the individual professional in the selected enrollment

Practice Information
Line 1 Street Address	12200 N BRENTFIELD DR LAKE OF THE WO PLZ
	Group Practice or individual's line 1 address
City	DUNLAP
	Group Practice or individual's city
State	IL
	Group Practice or individual's state
Zip Code	615259403
	Group Practice or individual's zip code (9 digits when available)
Phone Number	309243778133
	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	140067
	Medicare CCN of hospital where individual professional provides service 1
Hospital Affiliation LBN 1	OSF SAINT FRANCIS MEDICAL CENTER
	Legal business name of hospital where individual professional provides service 1
Hospital Affiliation CCN 2	140013
	Medicare CCN of hospital where individual professional provides service 2
Hospital Affiliation LBN 2	PROCTOR HOSPITAL
	Legal business name of hospital where individual professional provides service 2
Hospital Affiliation CCN 3	140209
	Medicare CCN of hospital where individual professional provides service 3
Hospital Affiliation LBN 3	METHODIST MEDICAL CENTER OF ILLINOIS
	Legal business name of hospital where individual professional provides service 3
Professional Accepts Medicare Assignment	Y