Andy Deetjeen

Primary specialty

Physician AssistantTaxonomy code 363A00000X

Practice address

2451 NW 41St Ave Apt 408
Lauderhill, FL 33313-3769

Phone

(646) 830-7804

NPI assigned

Oct 21, 2022

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

Medicare fee-for-service enrollment

Enrolled in AZ

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: Yes
• Power mobility devices: Yes
• Hospice: No

Green means eligible to order or refer.

Enrollment records 1

Specialty

Physician Assistant

Education

Other, 2018

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Telehealth

Offers telehealth services

Group practices

Mulberry Medical LLCGroup PAC ID 2365954450, 30 clinicians

Practice addresses (Care Compare)

Hospital & facility affiliations

• Angels Care Home Health Home health agency, Casa Grande, AZ, CCN 037252

Medicare enrollment (NPD)

Enrolled

Credentials

Physician Assistant

Practice roles

Interoperability endpoints

• FHIR API: https://fhir4.healow.com/fhir/r4/AHHIDD/Endpoint/AHHIDD

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.

• Mulberry Medical LLC

  • Family Medicine Physician
  • Tempe, AZ
  • NPI 1831980986
  Medicare reassignment Care Compare group
• Livi Medical Services LLC

  dba Elevation Primary and Palliative

  • Family Medicine Physician
  • Phoenix, AZ
  • NPI 1457667750
  Medicare reassignment
• Floyd I Miller DPM PC

  • Podiatric Clinic/Center
  • Chandler, AZ
  • NPI 1932227139
  NPD (past)
• Gregg Krahn DPM PC

  • Podiatrist
  • Chandler, AZ
  • NPI 1417129248
  NPD (past)
• Plastic and Peripheral Nerve Surgery LLC

  • Plastic and Reconstructive Surgery Physician
  • Sun Lakes, AZ
  • NPI 1760044325
  NPD (past)

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

• Angel Care Health Services, Inc.

  dba Angels Care Home Health

  • Home Health Agency
  • Casa Grande, AZ
  • NPI 1285771469
  Care Compare affiliation

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

{
    "created_epoch": "1666310400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1675382400000",
    "number": "1053038976",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "714 NW 62ND ST",
            "city": "MIAMI",
            "state": "FL",
            "postal_code": "331504332",
            "telephone_number": "786-655-0529"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2451 NW 41ST AVE APT 408",
            "city": "LAUDERHILL",
            "state": "FL",
            "postal_code": "333133769",
            "telephone_number": "646-830-7804"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "DEETJEEN",
        "first_name": "ANDY",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2022-10-21",
        "last_updated": "2023-02-03",
        "certification_date": "2023-02-03",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Gina Daye, A.R.N.P-C
• Alina Mariana De Leon
• Anatalie Dean
• Deborah E Luis DMD PA (Fresh Dental Smiles)
• Debsheba Empire Inc (99 Clinic)
• Michael Delez, PT
• Veronica Delgado, LCSW
• Selma C Delima, M.D.
• Demand Diagnostics Lab
• Danielle Demarest

• Physician Assistant in Lauderhill, FL
• Providers in Lauderhill, FL by specialty
• Physician Assistant in Florida

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 3, 2023; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.