Marque R Dietzler, P.A.

Primary specialty

Physician AssistantTaxonomy code 363A00000X

Practice address

11234 Anderson St
Loma Linda, CA 92354-2804

Phone

(909) 558-4444

NPI assigned

May 4, 2016

Last updated

Oct 13, 2021By the provider in NPPES

Sex

Female

Sole proprietor

Yes

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

Specialties & licenses 1

Addresses

Electronic endpoints 1

Medicare fee-for-service enrollment

Enrolled in CA

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, 2016

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

Larry C Hughes MD Inc a Medical CorporationGroup PAC ID 8426372988, 6 clinicians

La Laser Center PC a Professional Medical CorporationGroup PAC ID 9537181185, 81 clinicians

Practice addresses (Care Compare)

Merit-based Incentive Payment System (MIPS)

Final score

91.69 of 100Reported as group

Quality

91.59

Promoting interoperability

94

Improvement activities

40

Cost

76.9

Medicare enrollment (NPD)

Enrolled

Credentials

Physician Assistant

Practice roles

Locations

Networks

• BSC 65 PLUS INDIVIDUAL MAPD

Interoperability endpoints

• Direct secure messaging: marque.dietzler.p23@direct.kmsm.nextgenshare.com
• Direct secure messaging: mdietzler@lalasercenter.emadirect.md

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.

• La Laser Center, PC, a Professional Medical Corporation

  • Multi-Specialty Clinic/Center
  • San Clemente, CA
  • NPI 1306982855
  Medicare reassignment Care Compare group
• Larry C Hughes MD Inc a Medical Corporation

  • Family Medicine Physician
  • Hemet, CA
  • NPI 1861546681
  Medicare reassignment Care Compare group
• Faculty Physicians and Surgeons of Llusm

  • Thoracic Surgery (Cardiothoracic Vascular Surgery) Physician
  • Apple Valley, CA
  • NPI 1205009917
  Medicare reassignment
• Faculty Physicians and Surgeons of Llusm

  • Pediatrics Physician
  • Redlands, CA
  • NPI 1235189911
  NPD
• Faculty Physicians and Surgeons of Llusm

  • Family Medicine Physician
  • Moreno Valley, CA
  • NPI 1558788331
  NPD
• La Laser Center PC, a Professional Medical Corporation

  dba Visalia Dermatology & Skin Cancer

  • Non-Pharmacy Dispensing Site
  • Visalia, CA
  • NPI 1083247795
  NPD (past)
• La Laser Center PC, a Professional Medical Corporation

  dba Skin and Cancer Institute - Turlock

  • Non-Pharmacy Dispensing Site
  • Turlock, CA
  • NPI 1356974059
  NPD (past)

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

{
    "created_epoch": "1462320000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1634083200000",
    "number": "1073968459",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "11234 ANDERSON ST",
            "city": "LOMA LINDA",
            "state": "CA",
            "postal_code": "923542804",
            "telephone_number": "951-746-6126"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "11234 ANDERSON ST",
            "city": "LOMA LINDA",
            "state": "CA",
            "postal_code": "923542804",
            "telephone_number": "909-558-4444"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "4020 W Florida Ave",
            "address_purpose": "LOCATION",
            "city": "Hemet",
            "state": "CA",
            "postal_code": "925455279",
            "country_code": "US",
            "telephone_number": "951-925-9565",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "DIETZLER",
        "first_name": "MARQUE",
        "middle_name": "R",
        "credential": "P.A.",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2016-05-04",
        "last_updated": "2021-10-13",
        "certification_date": "2021-10-13",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "NU",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [
        {
            "endpointType": "SOAP",
            "endpointTypeDescription": "SOAP URL",
            "endpoint": "https://careepicwest.kp.org:14430/Interconnect-prodcalgateway/wcf/epic.community.hie/xcpdrespondinggatewaysync.svc/scalceq",
            "affiliation": "Y",
            "endpointDescription": "Carequality",
            "affiliationName": "Southern California Permanente Medical Group",
            "use": "HIE",
            "useDescription": "Health Information Exchange (HIE)",
            "contentType": "OTHER",
            "contentTypeDescription": "Other",
            "contentOtherDescription": "C-CDA",
            "address_1": "10800 Magnolia Ave",
            "city": "Riverside",
            "state": "CA",
            "country_code": "US",
            "postal_code": "925053043",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

• Brian Diep, DO
• My Diep, DO
• Aleece Christina Cazan Dietrich
• Alexandria Rose Dietrich
• Robin Lloyd Dietz Jr., MD
• Daniel J Dilorenzo, MD, PHD
• Tricia Maris Guadiz Dimaculangan, MD
• Chandler Hoang-Phi Dinh
• Wendy S Dio
• Devyn Alexandria Diorio

• Physician Assistant in Loma Linda, CA
• Providers in Loma Linda, CA by specialty
• Physician Assistant in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 13, 2021; 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.