Daniel Albert Cieslak, M.D.
Individual provider Active NPI Family Medicine Physician · Holloman Afb, NM
NPI 1255744652 · NPPES record last updated Apr 9, 2018
Key facts
- NPI
- 1255744652
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Family Medicine Physician 207Q00000X
- License
- 28880 (NE)
- Practice address
- 49TH Medical Group/Sgopf
280 First Street, BLDG 23
Holloman Afb, NM 88330-8273 - Phone
- (575) 572-7091
- Fax
- (575) 572-2259
- NPI assigned
- Jun 4, 2014
- Sex
- Male
- Sole proprietor
- No
Organizations & group practices 4
Hospital & facility affiliations 3
Medicare Care Compare profile
- Specialty
- Family Practice
- Education
- Medical College of Wisconsin, 2014
- Medicare assignment
- Accepts the Medicare-approved amount as payment in full
- Group practices
- Ihc Health Services Inc
Practice addresses (Care Compare)
955 E 11400
Sandy, UT 84094-6946
Phone (801) 571-0030
Hospital & facility affiliations
- Intermountain Health Alta View Hospital
- Intermountain Medical Center
- Intermountain Health Riverton Hospital
Procedures performed for Medicare patients
| Procedure | Number of procedures |
|---|---|
| Removal of skin lesions | 1-10 |
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in UT
- Eligible to order & refer
- Part B services: Yes · DME: Yes · Home health: Yes · Power mobility devices: Yes · Hospice: Yes
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20201007003063 | UT | Practitioner - Family Practice | 7214254952 | Reassigns benefits to 1 organization |
National Provider Directory
- Medicare enrollment (NPD)
- Yes
- Credentials
- Doctor of Medicine
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 28880 | NE | MD | Family Medicine Physician |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Ihc Health Services, Inc. | Current |
Accepting new patients | |
| Ihc Health Services Inc | Current | Accepting new patients | |
| Ihc Health Services Inc | Family Medicine | Current |
Accepting new patients |
| Ihc Health Services Inc | Past | Accepting new patients |
Locations
700 S Highway 99
Ste 3
Fillmore, UT 84631
Phone (435) 743-5555
955 E 11400 S
Sandy, UT 84094
Phone (801) 571-0030
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Student in an Organized Health Care Education/Training Program | 390200000X | |||
| Family Medicine Physician | 207Q00000X | 28880 | NE | Yes |
Addresses
Primary practice location
49TH Medical Group/Sgopf
280 First Street, BLDG 23
Holloman Afb, NM 88330-8273
Mailing address
49TH Medical Group/Sgopf
280 First Street, BLDG 23
Holloman Afb, NM 88330-8273
Phone (575) 572-7091
Other providers in Holloman Afb, NM
- Kendall Cannon
- Sara Kyong Cantu
- Gretta Carroll
- Amanda Carter
- Andrew Y J Cho
- Jodi Clary
- Katherine Cler
- Hayley Michelle Crandall
- Joshua P Crum
- Sebastian Alejandro Cruz
All providers in Holloman Afb, NM · Family Medicine Physician in New Mexico
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Apr 9, 2018. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- Order and Referring (CMS).
- Medicare Care Compare provider data (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.