NPIMap

Individual provider Active NPI

Alicia M Dietrich, PA-C

  • Physician Assistant
  • Wyomissing, PA
National Provider Identifier
1043307903
Registry record updated Aug 26, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physician AssistantTaxonomy code 363A00000X
License
MA052761 Issued in PA
Practice address
1320 Broadcasting Rd
Ste 200
Wyomissing, PA 19610-3222
Phone
(610) 372-8995
NPI assigned
Oct 10, 2006
Last updated
Aug 26, 2020By the provider in NPPES
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Aug 26, 2020

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Physician Assistant 363A00000X MA052761 PA Primary

Addresses

Primary practice location

1320 Broadcasting Rd
Ste 200
Wyomissing, PA 19610-3222

Mailing address

1320 Broadcasting Rd
Ste 200
Wyomissing, PA 19610-3222
Phone (610) 372-8995

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in PA
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
I20061025000238 PA Practitioner - Physician Assistant 8729085386 Reassigns benefits to 2 organizations

Care Compare profile

Medicare Care Compare
Specialty
Physician Assistant
Education
Other, 2006
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices

Practice addresses (Care Compare)

1320 Broadcasting Rd
Suite 200
Reading, PA 19610-3222
Phone (610) 372-8995

Hospital & facility affiliations

Merit-based Incentive Payment System (MIPS)

Final score
82.73 of 100Reported as group
Quality
79.68
Improvement activities
40

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Physician Assistant

Practice roles

OrganizationSpecialtyStatusNew patients
Center for Urologic Care of Berks Co PC CurrentSince Aug 14, 2006 Accepting new patients
Tower Health Medical Group CurrentSince Aug 1, 2011 Accepting new patients
Tower Health Medical Group CurrentSince Aug 1, 2011 Accepting new patients

Locations

301 S 7th Ave
Ste 130
West Reading, PA 19611
Phone (610) 988-4630

1320 Broadcasting Rd
Ste 200
Wyomissing, PA 19610
Phone (610) 372-8995

2610 Keiser Blvd
Wyomissing, PA 19610
Phone (484) 628-9127

Organizations & group practices 4

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.

Hospital & facility affiliations 9

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": "1160438400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1598400000000",
    "number": "1043307903",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1320 BROADCASTING RD",
            "address_2": "STE 200",
            "city": "WYOMISSING",
            "state": "PA",
            "postal_code": "196103222",
            "telephone_number": "610-372-8995"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1320 BROADCASTING RD",
            "address_2": "STE 200",
            "city": "WYOMISSING",
            "state": "PA",
            "postal_code": "196103222",
            "telephone_number": "610-372-8995"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "DIETRICH",
        "first_name": "ALICIA",
        "middle_name": "M",
        "name_prefix": "Ms.",
        "credential": "PA-C",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2006-10-10",
        "last_updated": "2020-08-26",
        "certification_date": "2020-08-26",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "PA",
            "license": "MA052761",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Wyomissing, PA

Sources for this page

Verify at the official NPI Registry.