Donald David Dietze Jr., MD
Individual provider Active NPI Neurological Surgery Physician · Lacombe, LA
NPI 1316913635 · NPPES record last updated Oct 1, 2015
Key facts
- NPI
- 1316913635
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Neurological Surgery Physician 207T00000X
- License
- 019033 (LA)
- Practice address
- 29301 N Dixie Ranch Rd
Lacombe, LA 70445 - Phone
- (985) 871-4114
- Fax
- (985) 871-4130
- NPI assigned
- Feb 27, 2006
- Sex
- Male
- Sole proprietor
- No
Organizations & group practices 3
Hospital & facility affiliations 1
Medicare Care Compare profile
- Specialty
- Neurosurgery
- Education
- Louisiana State University School of Medicine in New Orleans, 1986
- Medicare assignment
- Accepts the Medicare-approved amount as payment in full
Practice addresses (Care Compare)
29301 N Dixie Ranch Rd
Lacombe, LA 70445-5403
Phone (985) 871-4114
Hospital & facility affiliations
- Our Lady of the Lake Surgical Hospital
Procedures performed for Medicare patients
| Procedure | Number of procedures |
|---|---|
| Spinal fusion | 63 |
| Laminectomy or laminotomy (partial removal of spine bones) | 1-10 |
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in LA
- 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 |
|---|---|---|---|---|
| I20071008000546 | LA | Practitioner - Neurosurgery |
8921193723 | Reassigns benefits to 1 organization |
National Provider Directory
- Medicare enrollment (NPD)
- Yes
- Credentials
- Doctor of Medicine
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 019033 | LA | MD | Neurological Surgery Physician |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Spine Innovations, LLC | Current |
Accepting new patients | |
| The North Institute, Apmc | Past | Accepting new patients | |
| Surgical Spine Specialists, LLC | Past | Accepting new patients |
Locations
29301 N Dixie Ranch Rd
Lacombe, LA 70445
Phone (985) 871-4114
Interoperability endpoints
- donald.dietze@3638.securemail.prognocis.com
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Neurological Surgery Physician | 207T00000X | 019033 | LA | Yes |
Addresses
Primary practice location
29301 N Dixie Ranch Rd
Lacombe, LA 70445
Mailing address
29301 N Dixie Ranch Rd
Lacombe, LA 70445
Phone (985) 871-4114
Other identifiers
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 5E706 | Other | LA | MEDICARE PROVIDER NUMBER |
Other providers in Lacombe, LA
- Compounding Corner Inc.
- Covington Physician Services LLC
- Crescent Imaging, LLC
- Arthur Evan Davies Jr.
- Dietze & Logan Spine Specialist, LLC
- Cori D. Dysart Gagnard
- Adjuan Edgerson
- Brigitte Emanuel
- Emergency Group of Covington LLC
- Lorenzo Boykin Fisher
All providers in Lacombe, LA · Neurological Surgery Physician in Louisiana
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Oct 1, 2015. 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.