Amy L Dietrich, PA C

Primary specialty

Physician AssistantTaxonomy code 363A00000X

License

0598 Issued in SD

Practice address

705 Sioux Point Rd
Ste 100
Dakota Dunes, SD 57049

Phone

(605) 217-5500

Fax

(605) 217-5515

NPI assigned

Feb 24, 2006

Last updated

May 26, 2010By the provider in NPPES

Sex

Female

Sole proprietor

No

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

Specialties & licenses 2

Addresses

Other names 1

• Amy L Petersen Former name

Medicare fee-for-service enrollment

Enrolled in IA, SD2 enrollments

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 2

Specialty

Physician Assistant

Education

Other, 1996

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

Cnos PCGroup PAC ID 4284548942, 98 clinicians

Practice addresses (Care Compare)

Hospital & facility affiliations

• St Lukes Regional Medical Center Hospital, Sioux City, IA, CCN 160146

Merit-based Incentive Payment System (MIPS)

Final score

88.8 of 100Reported as apm

Quality

82.54

Promoting interoperability

89.05

Improvement activities

40

Medicare enrollment (NPD)

Enrolled

Credentials

Physician Assistant

State licenses

Practice roles

Locations

Interoperability endpoints

• Direct secure messaging: amydietrich@cnos.allscriptsdirect.net

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.

• Cnos PC

  • Orthopaedic Surgery Physician
  • Dakota Dunes, SD
  • NPI 1881604320

  IA

  Medicare reassignment Care Compare group NPD
• Cnos, PC

  • Orthopaedic Surgery Physician
  • South Sioux City, NE
  • NPI 1750047304
  NPD
• Diagnostic Radiology PC

  • Diagnostic Radiology Physician
  • Omaha, NE
  • NPI 1497713291
  NPD (past)
• Northwest Iowa Hospital Corporation

  dba St. Luke's Regional Medical Center

  • Emergency Medical Services (Emergency Medicine) Physician
  • Sioux City, IA
  • NPI 1215962550
  NPD (past)

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

• Northwest Iowa Hospital Corporation

  dba St Lukes Regional Medical Center

  • General Acute Care Hospital
  • Sioux City, IA
  • NPI 1962594622
  Care Compare affiliation

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

{
    "created_epoch": "1140739200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1274832000000",
    "number": "1053387522",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "705 SIOUX POINT RD",
            "address_2": "STE 100",
            "city": "DAKOTA DUNES",
            "state": "SD",
            "postal_code": "57049",
            "telephone_number": "605-217-5500",
            "fax_number": "605-217-5515"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "705 SIOUX POINT RD",
            "address_2": "STE 100",
            "city": "DAKOTA DUNES",
            "state": "SD",
            "postal_code": "57049",
            "telephone_number": "605-217-5500",
            "fax_number": "605-217-5515"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "DIETRICH",
        "first_name": "AMY",
        "middle_name": "L",
        "credential": "PA C",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2006-02-24",
        "last_updated": "2010-05-26",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "SD",
            "license": "0598",
            "primary": true
        },
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "SD",
            "license": "L1728",
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "AMY",
            "last_name": "PETERSEN",
            "middle_name": "L",
            "code": "1",
            "type": "Former Name"
        }
    ]
}

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• Physician Assistant in Dakota Dunes, SD
• Providers in Dakota Dunes, SD by specialty
• Physician Assistant in South Dakota

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 26, 2010; 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.