Physician Compare National (NPI:1770586737)

HEALTHCARE PROVIDER: TIMOTHY ALAN QUIST D.P.M.

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

Individual Professional Information
NPI	1770586737
	Unique healthcare provider (clinician) ID assigned by NPPES
PECOS UID	3274678446
	Unique individual clinician ID assigned by PECOS
Professional Enrollment ID	I20100301000000
	Unique ID for the individual professional enrollment that is the source for the data in the observation
Provider Last Name	QUIST
	Individual professional last name
Provider First Name	TIMOTHY
	Individual professional first name
Provider Middle Name	ALAN
	Individual professional middle name
Provider Gender	M
	The provider's gender if the provider is a person.

Medical School Information
Medical School Name	CALIFORNIA SCHOOL OF PODIATRIC MEDICINE
	Individual professional's medical school
Graduation Year	1989
	Individual professional's medical school graduation year
Primary Specialty	PODIATRY
	Primary medical specialty reported by the individual professional in the selected enrollment

Practice Information
Line 1 Street Address	24021 US HWY 33
	Group Practice or individual's line 1 address
City	ELKHART
	Group Practice or individual's city
State	IN
	Group Practice or individual's state
Zip Code	465173546
	Group Practice or individual's zip code (9 digits when available)

Hospital(s) Affiliation Information
Hospital Affiliation CCN 1	150026
	Medicare CCN of hospital where individual professional provides service 1
Hospital Affiliation LBN 1	GOSHEN HOSPITAL
	Legal business name of hospital where individual professional provides service 1
Professional Accepts Medicare Assignment	Y