Physician Compare National (NPI:1659315810)

HEALTHCARE PROVIDER: DAVID FJ TOLLEFSON MD

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

Individual Professional Information
NPI	1659315810
	Unique healthcare provider (clinician) ID assigned by NPPES
PECOS UID	0648275214
	Unique individual clinician ID assigned by PECOS
Professional Enrollment ID	I20100517000011
	Unique ID for the individual professional enrollment that is the source for the data in the observation
Provider Last Name	TOLLEFSON
	Individual professional last name
Provider First Name	DAVID
	Individual professional first name
Provider Middle Name	FJ
	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 WISCONSIN SCHOOL OF MEDICINE
	Individual professional's medical school
Graduation Year	1978
	Individual professional's medical school graduation year
Primary Specialty	GENERAL SURGERY
	Primary medical specialty reported by the individual professional in the selected enrollment
Secondary Specialty 1	VASCULAR SURGERY
	First secondary medical specialty reported by the individual professional in the selected enrollment
All Secondary Specialties	VASCULAR SURGERY
	All four secondary specialties reported by the individual professional in the selected enrollment, separated by commas

Practice Information
Organization Legal Name	SOUTH SOUND SURGICAL ASSOCIATES
	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	9537058847
	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	2
	Total number of individual professionals affiliated with the Group Practice based on Group Practice PAC ID
Line 1 Street Address	3920 CAPITAL MALL SWDR
	Group Practice or individual's line 1 address
Line 2 Street Address	SUITE 203
	Group Practice or individual's line 2 address
City	OLYMPIA
	Group Practice or individual's city
State	WA
	Group Practice or individual's state
Zip Code	985028702
	Group Practice or individual's zip code (9 digits when available)
Phone Number	3067543507
	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	500139
	Medicare CCN of hospital where individual professional provides service 1
Hospital Affiliation LBN 1	CAPITAL MEDICAL CENTER
	Legal business name of hospital where individual professional provides service 1
Professional Accepts Medicare Assignment	Y