NPIMap

Organization Active NPI

Thomas P Van Den Driessche

  • Family Medicine Physician
  • Fort Wayne, IN
National Provider Identifier
1538349956
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
Legal business name
THOMAS P VAN DEN DRIESSCHE
Practice address
3030 Lake Ave
Suite 32
Fort Wayne, IN 46805-5428
Phone
(260) 424-3134
Fax
(260) 424-3138
NPI assigned
Nov 14, 2007
Last updated
Nov 14, 2007By the provider in NPPES
Organization subpart
No

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

Authorized official

Name
Dr. Thomas P Van Den Driessche, M.D.NPI 1073507745
Title
Owner
Phone
(260) 424-3134

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 1

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

Addresses

Primary practice location

3030 Lake Ave
Suite 32
Fort Wayne, IN 46805-5428

Mailing address

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

Other identifiers 1

IdentifierTypeStateIssuer
CK2666OtherRR MEDICARE GROUP

National Provider Directory

National Provider Directory

Locations

3030 Lake Ave
Ste 19
Fort Wayne, IN 46805
Phone (260) 424-3134

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

Practitioners & affiliated clinicians

Practitioners 2

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

NPI Registry JSON

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

{
    "created_epoch": "1194998400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1194998400000",
    "number": "1538349956",
    "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": "SUITE 32",
            "city": "FORT WAYNE",
            "state": "IN",
            "postal_code": "468055428",
            "telephone_number": "260-424-3134",
            "fax_number": "260-424-3138"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "THOMAS P VAN DEN DRIESSCHE",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-11-14",
        "last_updated": "2007-11-14",
        "status": "A",
        "authorized_official_last_name": "VAN DEN DRIESSCHE",
        "authorized_official_first_name": "THOMAS",
        "authorized_official_middle_name": "P",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "260-424-3134",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "M.D."
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "IN",
            "license": "01028709A",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "RR MEDICARE GROUP",
            "identifier": "CK2666",
            "state": null
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Fort Wayne, IN

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 14, 2007; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.