NPIMap

Individual provider Active NPI

Thomas P Van Den Driessche, M.D.

  • Family Medicine Physician
  • Fort Wayne, IN
National Provider Identifier
1073507745
Registry record updated Nov 14, 2007
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Medicine PhysicianTaxonomy code 207Q00000X
License
01028709A Issued in IN
Practice address
3030 Lake Ave
Suite32
Fort Wayne, IN 46805-5428
Phone
(260) 424-3134
Fax
(260) 424-3138
NPI assigned
Sep 8, 2005
Sex
Male
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Nov 14, 2007

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Family Medicine Physician 207Q00000X 01028709A IN Primary

Addresses

Primary practice location

3030 Lake Ave
Suite32
Fort Wayne, IN 46805-5428

Mailing address

3030 Lake Ave
Suite 32
Fort Wayne, IN 46805-5428
Phone (260) 424-3134

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in IN
Eligible to order & refer
  • Part B services
  • Medical equipment
  • Home health
  • Power mobility devices
  • Hospice
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20051114000365 IN Practitioner - Family Practice 3678592292 Reassigns benefits to 5 organizations
Practice locations: Fort Wayne, IN

Care Compare profile

Medicare Care Compare
Specialty
Family Practice
Education
Indiana University School of Medicine, 1978
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Eventus Ecs, IncGroup PAC ID 2163969650, 243 clinicians
Theoria MedicalGroup PAC ID 5395098339, 317 clinicians
Rpinmd LLCGroup PAC ID 4183014616, 13 clinicians
Extended Care Specialists, IncGroup PAC ID 2466407713, 295 clinicians

Practice addresses (Care Compare)

150 W Market St
Suite 400
Indianapolis, IN 46204-2810
Phone (855) 743-2247

1700 I St
La Porte, IN 46350-5750
Phone (219) 362-6234

6326 Constitution Dr
Fort Wayne, IN 46804-1518
Phone (260) 515-3275

8398 Mississippi St
FL 2
Merrillville, IN 46410-6316
Phone (855) 743-2247

Hospital & facility affiliations

  • Paradigm Health Hospice, Indianapolis, IN, CCN 151611
  • Dunes Hospice LLC Hospice, Valparaiso, IN, CCN 151614
  • Community Hospital of Bremen Inc Hospital, Bremen, IN, CCN 151300
  • Wellbrooke of Wabash Nursing home, Wabash, IN, CCN 155806
  • Brickyard Healthcare - Terrace Care Center Nursing home, La Porte, IN, CCN 155136
  • Brickyard Healthcare - Laporte Care Center Nursing home, La Porte, IN, CCN 155062
  • Waters of Syracuse Skilled Nursing Facility, the Nursing home, Syracuse, IN, CCN 155581

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Not enrolled
HHS exclusion list flag
Flagged The directory lists this NPI on an HHS exclusion list. The OIG exclusions file (LEIE) holds no record for this NPI, and the directory does not say which list the flag comes from. How exclusions are shown Confirm with the OIG exclusions search.
Credentials
Doctor of Medicine

State licenses

LicenseStateTypeSpecialty
01028709AINMDFamily Medicine Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Theoria Medical CurrentSince Jun 9, 2025 Accepting new patients
Extended Care Specialists, Inc Family Medicine CurrentSince Jan 1, 2021 Accepting new patients
Eventus Ecs, Inc Family Medicine CurrentSince Jun 1, 2024 Accepting new patients
Rpinmd LLC Family Medicine CurrentSince Jun 12, 2025 Accepting new patients
Eventus WH Midwest Care, LLC Family Medicine CurrentSince Dec 16, 2024 Accepting new patients
Thomas P Van Den Driessche Family Medicine PastSince Jan 1, 1990 Accepting new patients
Lima Memorial Joint Operating Company Past Accepting new patients
St Joseph Medical Group Inc Family Medicine Past Accepting new patients

Locations

155 E Burks Dr
Bloomington, IN 47401
Phone (812) 322-4437

2100 Midway St
Columbus, IN 47201
Phone 3178181240225

6326 Constitution Dr
Fort Wayne, IN 46804
Phone (260) 515-3275

3512 Stellhorn Rd
Fort Wayne, IN 46815

150 W Market St
Ste 400
Indianapolis, IN 46204

1900 Andrew Ave
Laporte, IN 46350
Phone (219) 362-6234

1700 I St
Laporte, IN 46350
Phone (219) 362-6234

8398 Mississippi St
Fl 2
Merrillville, IN 46410

41800 W 11 Mile Rd
Ste 109
Novi, MI 48375
Phone (833) 578-2763

Ownership & related parties

All facility ownership & control disclosures 4

Facilities whose Medicare enrollment lists this provider’s PECOS associate ID as an owner or managing party.

FacilityTypeRoleSince
Millers at Oak PointeColumbia City, IN, CCN 155128 Skilled nursing facility Operational/Managerial Control
Adp of the SNF		 Jan 1, 2025
Jul 7, 2025
Belltower Health & Rehabilitation CenterGranger, IN, CCN 155850 Skilled nursing facility Operational/Managerial Control
Adp of the SNF		 Jan 1, 2021
Jan 1, 2021
Life Care Center of Ft WayneFort Wayne, IN, CCN 155266 Skilled nursing facility Operational/Managerial Control
Adp of the SNF		 May 1, 2021
May 1, 2021
Life Care Center of RochesterRochester, IN, CCN 155379 Skilled nursing facility Operational/Managerial Control
Adp of the SNF		 Jul 5, 1952
Jul 1, 2022

Owned or controlled facilities with NPI records 4

Facilities whose Medicare enrollment lists this provider as an owner, officer, director or managing party.

Organizations & group practices 8

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

Hospital & facility affiliations 7

Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1126137600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1194998400000",
    "number": "1073507745",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3030 LAKE AVE",
            "address_2": "SUITE 32",
            "city": "FORT WAYNE",
            "state": "IN",
            "postal_code": "468055428",
            "telephone_number": "260-424-3134",
            "fax_number": "260-424-3138"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3030 LAKE AVE",
            "address_2": "SUITE32",
            "city": "FORT WAYNE",
            "state": "IN",
            "postal_code": "468055428",
            "telephone_number": "260-424-3134",
            "fax_number": "260-424-3138"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "VAN DEN DRIESSCHE",
        "first_name": "THOMAS",
        "middle_name": "P",
        "credential": "M.D.",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2005-09-08",
        "last_updated": "2007-11-14",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "IN",
            "license": "01028709A",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Fort Wayne, IN

Sources for this page

Verify at the official NPI Registry.