Active NPI
Terry J Dietrich, MD
- Orthopaedic Surgery Physician
- New London, WI
National Provider Identifier
1245274141
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Orthopaedic Surgery Physician
- License
- 49333-020
- Practice address
- 1405 Mill St
New London, WI 54961-2155 - Phone
- (920) 831-5050
- NPI assigned
- Jun 15, 2006
- Sex
- Male
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Orthopaedic Surgery Physician | 207X00000X | 49333-020 | WI | Primary |
Addresses
Primary practice location
1405 Mill St
New London, WI 54961-2155
Mailing address
PO Box 8003
Appleton, WI 54912-8003
Phone (920) 996-3298
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 450030720 | Other | WI | MEDICARE PTAN |
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
- Credentials
- Doctor of Medicine
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 49333-020 | WI | MD | Orthopaedic Surgery Physician |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1150329600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1322006400000",
"number": "1245274141",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "PO BOX 8003",
"city": "APPLETON",
"state": "WI",
"postal_code": "549128003",
"telephone_number": "920-996-3298",
"fax_number": "920-738-5787"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1405 MILL ST",
"city": "NEW LONDON",
"state": "WI",
"postal_code": "549612155",
"telephone_number": "920-831-5050"
}
],
"practiceLocations": [],
"basic": {
"last_name": "DIETRICH",
"first_name": "TERRY",
"middle_name": "J",
"credential": "MD",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2006-06-15",
"last_updated": "2011-11-23",
"status": "A"
},
"taxonomies": [
{
"code": "207X00000X",
"taxonomy_group": "",
"desc": "Orthopaedic Surgery",
"state": "WI",
"license": "49333-020",
"primary": true
}
],
"identifiers": [
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "MEDICARE PTAN",
"identifier": "450030720",
"state": "WI"
}
],
"endpoints": [],
"other_names": []
}Other providers in New London, WI
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 23, 2011; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.