Active NPI
Jessica Rose Dietrich
- Registered Dietitian
- Eugene, OR
National Provider Identifier
1205502580
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Registered Dietitian
- License
- LD-D10209815
- Practice address
- 2639 Donegal St
Eugene, OR 97404-1963 - Phone
- (217) 370-5863
- Fax
- (866) 244-8819
- NPI assigned
- Aug 18, 2021
- Sex
- Female
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 3
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Registered Dietitian | 133V00000X | DT89050 | TX | |
| Registered Dietitian | 133V00000X | DI61023969 | WA | |
| Registered Dietitian | 133V00000X | LD-D10209815 | OR | Primary |
Addresses
Primary practice location
2639 Donegal St
Eugene, OR 97404-1963
Mailing address
2639 Donegal St
Eugene, OR 97404-1963
Phone (217) 370-5863
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)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| LD-D10209815 | OR | MD | Registered Dietitian |
| DT89050 | TX | MD | Registered Dietitian |
| DI61023969 | WA | MD | Registered Dietitian |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1629244800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1699228800000",
"number": "1205502580",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "2639 DONEGAL ST",
"city": "EUGENE",
"state": "OR",
"postal_code": "974041963",
"telephone_number": "217-370-5863",
"fax_number": "866-244-8819"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "2639 DONEGAL ST",
"city": "EUGENE",
"state": "OR",
"postal_code": "974041963",
"telephone_number": "217-370-5863",
"fax_number": "866-244-8819"
}
],
"practiceLocations": [],
"basic": {
"last_name": "DIETRICH",
"first_name": "JESSICA",
"middle_name": "ROSE",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2021-08-18",
"last_updated": "2023-11-06",
"certification_date": "2023-11-06",
"status": "A"
},
"taxonomies": [
{
"code": "133V00000X",
"taxonomy_group": "",
"desc": "Dietitian, Registered",
"state": "TX",
"license": "DT89050",
"primary": false
},
{
"code": "133V00000X",
"taxonomy_group": "",
"desc": "Dietitian, Registered",
"state": "WA",
"license": "DI61023969",
"primary": false
},
{
"code": "133V00000X",
"taxonomy_group": "",
"desc": "Dietitian, Registered",
"state": "OR",
"license": "LD-D10209815",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Eugene, OR
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 6, 2023; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.