Jonathan L Dieter Jr., MD

Primary specialty

Family Medicine PhysicianTaxonomy code 207Q00000X

License

7055 Issued in SC

Practice address

8014 Myrtle Trace Dr
Conway, SC 29526-8945

Phone

(843) 347-7224

Fax

(843) 347-7335

NPI assigned

Jan 15, 2007

Last updated

Oct 10, 2007By the provider in NPPES

Sex

Male

Sole proprietor

Yes

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

Specialties & licenses 1

Addresses

Other identifiers 1

Medicare fee-for-service enrollment

Enrolled in SC

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

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Medicine

State licenses

Practice roles

Locations

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.

• Coastal Family Medicine

  • Legal Medicine
  • Conway, SC
  • NPI 1548459597
  NPD Authorized official
• Advanced Practice Mental Health and Wellness of South Carolina L.L.C.

  • Psychiatric/Mental Health Nurse Practitioner
  • Myrtle Beach, SC
  • NPI 1720762503
  NPD (past)

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

{
    "created_epoch": "1168819200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1191974400000",
    "number": "1205987419",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "8014 MYRTLE TRACE DR",
            "city": "CONWAY",
            "state": "SC",
            "postal_code": "295268945",
            "telephone_number": "843-347-7224",
            "fax_number": "843-347-7335"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "8014 MYRTLE TRACE DR",
            "city": "CONWAY",
            "state": "SC",
            "postal_code": "295268945",
            "telephone_number": "843-347-7224",
            "fax_number": "843-347-7335"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "DIETER",
        "first_name": "JONATHAN",
        "middle_name": "L",
        "name_suffix": "Jr.",
        "credential": "MD",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2007-01-15",
        "last_updated": "2007-10-10",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "SC",
            "license": "7055",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "PC4269",
            "state": "SC"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Austin Blake Clark Dew III, PHARMD
• Stephen Dew, PHARMD
• Mayme Dewey
• Derrica Dewitt
• Anna Dickinson
• Wyatt H Dimmick, DPT, PT
• Tiffany Dianne Dineen, AGNP-C
• Terry Carlyle Dixon, M.D., PH.D.
• Doctors Care SC, PA (Doctors Care Conway Main Street)
• Doctors Care SC, PA (Doctors Care Conway 501)

• Family Medicine Physician in Conway, SC
• Providers in Conway, SC by specialty
• Family Medicine Physician in South Carolina

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 10, 2007; 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.