NPIMap

Organization Active NPI

Jon F Dietlein MD PA

  • Ophthalmology Physician
  • Georgetown, TX
National Provider Identifier
1285797621
Registry record updated Apr 17, 2009
On this page

Key facts

NPPES NPI Registry
Primary specialty
Ophthalmology PhysicianTaxonomy code 207W00000X
License
H0298 Issued in TX
Legal business name
JON F DIETLEIN MD PA
Practice address
311 River Bend Dr
Georgetown, TX 78628-2782
Phone
(512) 931-2255
Fax
(512) 819-9528
NPI assigned
Dec 18, 2006
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Apr 17, 2009

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

Authorized official

Name
Dr. Jon F Dietlein, M.D.NPI 1811901887
Title
President
Phone
(512) 931-2255

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
OptometristGroup: 193200000X MULTI-SPECIALTY GROUP 152W00000X 04076T TX
Ophthalmology PhysicianGroup: 193200000X MULTI-SPECIALTY GROUP 207W00000X H0298 TX Primary

Addresses

Primary practice location

311 River Bend Dr
Georgetown, TX 78628-2782

Mailing address

311 River Bend Dr
Georgetown, TX 78628-2782
Phone (512) 931-2255

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in TX

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20051219000709 TX Part B Supplier - Clinic/Group Practice 4486676491 Receives reassigned benefits from 4 practitioners
Practice locations: Georgetown, TX

Other NPIs with the same Medicare PAC ID 1

NPIs whose Medicare enrollments share a PECOS associate control ID (the same enrolled entity).

National Provider Directory

National Provider Directory
Tax ID family
Jon F Dietlein MD PA2 organizations share this tax ID, including this one

Other organizations with this tax ID 1

Organizations that report the same tax identification number in the National Provider Directory.

Practitioners & affiliated clinicians

Practitioners 4

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

NPI Registry JSON

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

{
    "created_epoch": "1166400000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1239926400000",
    "number": "1285797621",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "311 RIVER BEND DR",
            "city": "GEORGETOWN",
            "state": "TX",
            "postal_code": "786282782",
            "telephone_number": "512-931-2255",
            "fax_number": "512-819-9528"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "311 RIVER BEND DR",
            "city": "GEORGETOWN",
            "state": "TX",
            "postal_code": "786282782",
            "telephone_number": "512-931-2255",
            "fax_number": "512-819-9528"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "JON F DIETLEIN MD PA",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-12-18",
        "last_updated": "2009-04-17",
        "status": "A",
        "authorized_official_last_name": "DIETLEIN",
        "authorized_official_first_name": "JON",
        "authorized_official_middle_name": "F",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "512-931-2255",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "M.D."
    },
    "taxonomies": [
        {
            "code": "152W00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Optometrist",
            "state": "TX",
            "license": "04076T",
            "primary": false
        },
        {
            "code": "207W00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Ophthalmology",
            "state": "TX",
            "license": "H0298",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Georgetown, TX

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 17, 2009; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.