Timothy John Dietrich, D.O

Primary specialty

Internal Medicine PhysicianTaxonomy code 207R00000X

License

E-3259 Issued in AR

Practice address

1705 Club Manor Drive,
Suite 2
Maumelle, AR 72113-7401

Phone

(501) 851-7402

Fax

(501) 851-4753

NPI assigned

Apr 2, 2013

Sex

Male

Sole proprietor

No

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

Specialties & licenses 2

Addresses

Medicare fee-for-service enrollment

Enrolled in AR

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: Yes
• Power mobility devices: Yes
• Hospice: Yes

Green means eligible to order or refer.

Enrollment records 1

Specialty

Internal Medicine

Education

Other, 2013

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

Arkansas Health GroupGroup PAC ID 7911802079, 645 clinicians

Practice addresses (Care Compare)

Hospital & facility affiliations

• Baptist Health Medical Center-Little Rock Hospital, Little Rock, AR, CCN 040114
• Baptist Health Medical Center-Arkadelphia Hospital, Arkadelphia, AR, CCN 041321
• Baptist Health Medical Center-Drew County Hospital, Monticello, AR, CCN 040051
• Baptist Health Medical Center North Little Rock Hospital, North Little Rock, AR, CCN 040036
• St Marys Regional Medical Center Hospital, Russellville, AR, CCN 040041

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Osteopathy

State licenses

Practice roles

Locations

Interoperability endpoints

• Direct secure messaging: tdietrich150084@direct.baptist-healthar.org

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.

• Arkansas Health Group

  • Internal Medicine Physician
  • Maumelle, AR
  • NPI 1932118890
  Medicare reassignment Care Compare group NPD
• Baptist Health

  • Cardiovascular Disease Physician
  • Little Rock, AR
  • NPI 1578593067
  Medicare reassignment NPD
• Arkansas Health Group

  • Surgery Physician
  • Stuttgart, AR
  • NPI 1952840555
  NPD
• Baptist Health

  • Multi-Specialty Clinic/Center
  • Heber Springs, AR
  • NPI 1932081221
  NPD

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

• Baptist Health

  • General Acute Care Hospital
  • Little Rock, AR
  • NPI 1043240682
  Care Compare affiliation
• Baptist Health

  • Critical Access Hospital
  • Arkadelphia, AR
  • NPI 1174553796
  Care Compare affiliation
• Baptist Health

  • General Acute Care Hospital
  • North Little Rock, AR
  • NPI 1497790042
  Care Compare affiliation
• Baptist Health

  • General Acute Care Hospital
  • Monticello, AR
  • NPI 1962283192
  Care Compare affiliation
• Russellville Holdings LLC

  • General Acute Care Hospital
  • Russellville, AR
  • NPI 1033160049
  Care Compare affiliation

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

{
    "created_epoch": "1364860800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1472774400000",
    "number": "1053654608",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1701 CLUB MANOR DRIVE",
            "address_2": ", SUITE 2",
            "city": "MAUMELLE",
            "state": "AR",
            "postal_code": "721137401",
            "telephone_number": "501-851-7402",
            "fax_number": "501-851-4753"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1705 CLUB MANOR DRIVE,",
            "address_2": "SUITE 2",
            "city": "MAUMELLE",
            "state": "AR",
            "postal_code": "721137401",
            "telephone_number": "501-851-7402",
            "fax_number": "501-851-4753"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "DIETRICH",
        "first_name": "TIMOTHY",
        "middle_name": "JOHN",
        "name_prefix": "Dr.",
        "credential": "D.O",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2013-04-02",
        "last_updated": "2016-09-02",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207R00000X",
            "taxonomy_group": "",
            "desc": "Internal Medicine",
            "state": "AR",
            "license": "E-3259",
            "primary": true
        },
        {
            "code": "390200000X",
            "taxonomy_group": "",
            "desc": "Student in an Organized Health Care Education/Training Program",
            "state": null,
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• Internal Medicine Physician in Maumelle, AR
• Providers in Maumelle, AR by specialty
• Internal Medicine Physician in Arkansas

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 2, 2016; 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.