Alexis Dietz, DO

Primary specialty

Pediatrics PhysicianTaxonomy code 208000000X

License

OS17835 Issued in FL

Practice address

915 Middle River Dr Ste 209
Fort Lauderdale, FL 33304-3559

Phone

(954) 300-1736

NPI assigned

Jun 28, 2018

Last updated

Jan 12, 2023By 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 1

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Eligible to order & refer

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

Green means eligible to order or refer.

Medicare enrollment (NPD)

Not enrolled

Credentials

Doctor of Osteopathy

State licenses

Practice roles

Locations

Interoperability endpoints

• Direct secure messaging: alexis.dietz@385342882512900.direct.elationemr.com

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.

• Coral Ridge Pediatrics Inc.

  • Pediatrics Physician
  • Fort Lauderdale, FL
  • NPI 1366113961
  NPD

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

{
    "created_epoch": "1530144000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1673481600000",
    "number": "1083109243",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2500 NE 21ST CT",
            "city": "FORT LAUDERDALE",
            "state": "FL",
            "postal_code": "333053516",
            "telephone_number": "941-780-5738"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "915 MIDDLE RIVER DR STE 209",
            "city": "FORT LAUDERDALE",
            "state": "FL",
            "postal_code": "333043559",
            "telephone_number": "954-300-1736"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "DIETZ",
        "first_name": "ALEXIS",
        "credential": "DO",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2018-06-28",
        "last_updated": "2023-01-12",
        "certification_date": "2023-01-12",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "208000000X",
            "taxonomy_group": "",
            "desc": "Pediatrics",
            "state": "FL",
            "license": "OS17835",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Raina Diedrick, PHYSICIAN ASSISTANT
• Dietella LLC
• Dietitian Karen LLC
• Nastassia Dietrich
• Grace Dietsch, DO
• Michael Digiorgio, M.D.
• Teresa Dilbert
• Evan H Dillon, MD
• Angela Briana Dilworth
• Frank Joseph Dimaggio, PT

• Pediatrics Physician in Fort Lauderdale, FL
• Providers in Fort Lauderdale, FL by specialty
• Pediatrics Physician in Florida

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 12, 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.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.