Individual provider Active NPI

Mindy Diller

  • Metabolic Nutrition Registered Dietitian
  • Lubbock, TX
National Provider Identifier
1073931200
Registry record updated Oct 30, 2014
On this page

Key facts

NPPES NPI Registry
Primary specialty
Metabolic Nutrition Registered DietitianTaxonomy code 133VN1006X
License
DT83120 Issued in TX
Practice address
2431 S Loop 289
Lubbock, TX 79423-1519
Phone
(806) 771-7661
NPI assigned
Apr 4, 2014
Last updated
Oct 30, 2014By the provider in NPPES
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Oct 30, 2014

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Metabolic Nutrition Registered Dietitian 133VN1006X DT83120 TX Primary

Addresses

Primary practice location

2431 S Loop 289
Lubbock, TX 79423-1519

Mailing address

2431 S Loop 289
Lubbock, TX 79423-1519
Phone (806) 771-7661

Other identifiers 2

IdentifierTypeStateIssuer
337183301MedicaidTX
8EG102OtherTXBLUE CROSS BLUE SHIELD

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Not listed in the public Medicare enrollment file

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

NPI Registry JSON

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

{
    "created_epoch": "1396569600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1414627200000",
    "number": "1073931200",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2431 S LOOP 289",
            "city": "LUBBOCK",
            "state": "TX",
            "postal_code": "794231519",
            "telephone_number": "806-771-7661"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2431 S LOOP 289",
            "city": "LUBBOCK",
            "state": "TX",
            "postal_code": "794231519",
            "telephone_number": "806-771-7661"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "DILLER",
        "first_name": "MINDY",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2014-04-04",
        "last_updated": "2014-10-30",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "133VN1006X",
            "taxonomy_group": "",
            "desc": "Dietitian, Registered, Nutrition, Metabolic",
            "state": "TX",
            "license": "DT83120",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "337183301",
            "state": "TX"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BLUE CROSS BLUE SHIELD",
            "identifier": "8EG102",
            "state": "TX"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Lubbock, TX

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 30, 2014; 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.