Physician Compare National (NPI:1891223558)

HEALTHCARE PROVIDER: DIANE HENDRICKS LCSW

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

Individual Professional Information
NPI	1891223558
	Unique healthcare provider (clinician) ID assigned by NPPES
PECOS UID	9931462777
	Unique individual clinician ID assigned by PECOS
Professional Enrollment ID	I20180410000437
	Unique ID for the individual professional enrollment that is the source for the data in the observation
Provider Last Name	HENDRICKS
	Individual professional last name
Provider First Name	DIANE
	Individual professional first name
Provider Gender	F
	The provider's gender if the provider is a person.

Medical School Information
Medical School Name	OTHER
	Individual professional's medical school
Graduation Year	1985
	Individual professional's medical school graduation year
Primary Specialty	CLINICAL SOCIAL WORKER
	Primary medical specialty reported by the individual professional in the selected enrollment

Practice Information
Organization Legal Name	MIDAMERICARE LIMITED LIABILITY COMPANY
	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	4284768516
	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	14
	Total number of individual professionals affiliated with the Group Practice based on Group Practice PAC ID
Line 1 Street Address	501 W 107TH ST
	Group Practice or individual's line 1 address
Line 2 Street Address	BROOKDALE WORNALL PL
	Group Practice or individual's line 2 address
City	KANSAS CITY
	Group Practice or individual's city
State	MO
	Group Practice or individual's state
Zip Code	641145919
	Group Practice or individual's zip code (9 digits when available)
Phone Number	8163988448
	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