NPIMap

Individual provider Active NPI

Nicole Alyssa Emma Dietz, MD, PHD

  • Neurology Physician
  • Fairfax, VA
National Provider Identifier
1265595623
Registry record updated Jun 8, 2022
On this page

Key facts

NPPES NPI Registry
Primary specialty
Neurology PhysicianTaxonomy code 2084N0400X
License
0101250750 Issued in VA
Practice address
3020 Hamaker CT
Suite 400
Fairfax, VA 22031-2238
Phone
(703) 876-0800
Fax
(703) 876-0866
NPI assigned
Dec 18, 2006
Last updated
Jun 8, 2022By the provider in NPPES
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jun 8, 2022

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Brain Injury Medicine (Psychiatry & Neurology) Physician 2084P0301X 0101250750 VA
Neurology Physician 2084N0400X 0101250750 VA Primary

Addresses

Primary practice location

3020 Hamaker CT
Suite 400
Fairfax, VA 22031-2238

Mailing address

3020 Hamaker CT
Suite 400
Fairfax, VA 22031-2238
Phone (703) 876-0800

Other identifiers 1

IdentifierTypeStateIssuer
1265595623MedicaidVA

Electronic endpoints 1

TypeEndpointUseAffiliation
Direct Messaging Address clinical@ncf.directbygreenway.com Direct

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in DC
Eligible to order & refer
  • Part B services
  • Medical equipment
  • Home health
  • Power mobility devices
  • Hospice
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20130827000354 DC Practitioner - Neurology 3678716495 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Neurology
Education
Georgetown University School of Medicine, 2006
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Telehealth
Offers telehealth services
Group practices
Neurology Center of Fairfax, LTDGroup PAC ID 3577558659, 14 clinicians

Practice addresses (Care Compare)

3020 Hamaker CT
Suite 400
Fairfax, VA 22031-2220
Phone 70387608001208

Hospital & facility affiliations

Merit-based Incentive Payment System (MIPS)

Final score
100 of 100Reported as group
Promoting interoperability
100
Improvement activities
40

Procedures performed for Medicare patients

ProcedureNumber of procedures
Skin biopsy70

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Doctor of Medicine, Doctor of Philosophy

State licenses

LicenseStateTypeSpecialty
0101250750VAMDBrain Injury Medicine (Psychiatry & Neurology) Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Neurology Center of Fairfax, LTD Neurology CurrentSince Jul 19, 2013 Accepting new patients

Locations

3020 Hamaker Ct
Fairfax, VA 22031
Phone (703) 207-0073

3020 Hamaker Ct
Ste 400
Fairfax, VA 22031
Phone (703) 864-0800

Interoperability endpoints

  • Direct secure messaging: clinical@ncf.directbygreenway.com

Organizations & group practices 1

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.

Hospital & facility affiliations 7

Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.

NPI Registry JSON

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

{
    "created_epoch": "1166400000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1654646400000",
    "number": "1265595623",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3020 HAMAKER CT",
            "address_2": "SUITE 400",
            "city": "FAIRFAX",
            "state": "VA",
            "postal_code": "220312238",
            "telephone_number": "703-876-0800",
            "fax_number": "703-876-0866"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3020 HAMAKER CT",
            "address_2": "SUITE 400",
            "city": "FAIRFAX",
            "state": "VA",
            "postal_code": "220312238",
            "telephone_number": "703-876-0800",
            "fax_number": "703-876-0866"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "DIETZ",
        "first_name": "NICOLE",
        "middle_name": "ALYSSA EMMA",
        "name_prefix": "Dr.",
        "credential": "MD, PHD",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2006-12-18",
        "last_updated": "2022-06-08",
        "certification_date": "2022-06-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "2084P0301X",
            "taxonomy_group": "",
            "desc": "Psychiatry & Neurology, Brain Injury Medicine",
            "state": "VA",
            "license": "0101250750",
            "primary": false
        },
        {
            "code": "2084N0400X",
            "taxonomy_group": "",
            "desc": "Psychiatry & Neurology, Neurology",
            "state": "VA",
            "license": "0101250750",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1265595623",
            "state": "VA"
        }
    ],
    "endpoints": [
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "clinical@ncf.directbygreenway.com",
            "affiliation": "N",
            "use": "DIRECT",
            "useDescription": "Direct",
            "address_1": "3020 Hamaker Ct",
            "address_2": "SUITE 400",
            "city": "Fairfax",
            "state": "VA",
            "country_code": "US",
            "postal_code": "220312238",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

Other providers in Fairfax, VA

Sources for this page

Verify at the official NPI Registry.