Richard Paul Driessnack, M.D.

Primary specialty

Adult Reconstructive Orthopaedic Surgery PhysicianTaxonomy code 207XS0114X

License

36077466 Issued in IL

Practice address

303 N William Kumpf Blvd
Peoria, IL 61605-2507

Phone

(309) 676-5546

Fax

(309) 676-5045

NPI assigned

Jul 28, 2005

Last updated

Nov 2, 2010By the provider in NPPES

Sex

Male

Sole proprietor

No

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

Specialties & licenses 1

Addresses

Other identifiers 1

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Medicine

State licenses

Practice roles

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

• Tennessee Sports Medicine & Orthopaedics, PC

  dba Tennessee Sports Medicine & Orthopaedics

  • Specialist
  • Mount Juliet, TN
  • NPI 1154365104
  NPD (past)

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

{
    "created_epoch": "1122508800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1288656000000",
    "number": "1679573901",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "303 N WILLIAM KUMPF BLVD",
            "city": "PEORIA",
            "state": "IL",
            "postal_code": "616052507",
            "telephone_number": "309-676-5546",
            "fax_number": "309-676-5045"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "303 N WILLIAM KUMPF BLVD",
            "city": "PEORIA",
            "state": "IL",
            "postal_code": "616052507",
            "telephone_number": "309-676-5546",
            "fax_number": "309-676-5045"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "DRIESSNACK",
        "first_name": "RICHARD",
        "middle_name": "PAUL",
        "credential": "M.D.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2005-07-28",
        "last_updated": "2010-11-02",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207XS0114X",
            "taxonomy_group": "",
            "desc": "Orthopaedic Surgery, Adult Reconstructive Orthopaedic Surgery",
            "state": "IL",
            "license": "36077466",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "36077466",
            "state": "IL"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Dr. Richard D. Corley, S.C.
• Catherine Drake
• Zachary Scott Drawhon, APRN, FNP-C
• Douglas Cort Drenckpohl, DCN, RD
• Timothy Drew
• Anthony M Driscoll
• Emily Anne Driscoll, APRN
• Julie Ann Driscoll, APN
• Ashley Renee Droege, PA-C
• DRS. Shay and Associates, LTD.

• Adult Reconstructive Orthopaedic Surgery Physician in Peoria, IL
• Providers in Peoria, IL by specialty
• Adult Reconstructive Orthopaedic Surgery Physician in Illinois

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 2, 2010; 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.