Individual provider Active NPI

Peter Dietze Jr., MD

  • Obstetrics & Gynecology Physician
  • San Diego, CA
National Provider Identifier
1336259290
Registry record updated Jun 18, 2013
On this page

Key facts

NPPES NPI Registry
Primary specialty
Obstetrics & Gynecology PhysicianTaxonomy code 207V00000X
License
G 79877 Issued in CA
Practice address
10243 Genetic Center Dr
San Diego, CA 92121-6310
Phone
(858) 499-2702
Fax
(858) 526-6113
NPI assigned
Aug 30, 2006
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jun 18, 2013

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Obstetrics & Gynecology Physician 207V00000X G 79877 CA Primary

Addresses

Primary practice location

10243 Genetic Center Dr
San Diego, CA 92121-6310

Mailing address

10243 Genetic Center Dr
San Diego, CA 92121-6310
Phone (858) 499-2702

Other identifiers 1

IdentifierTypeStateIssuer
00G 798770MedicaidCA

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20070918000488 CA Practitioner - Obstetrics/Gynecology 5092809335 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Obstetrics/Gynecology
Education
University of California, San Diego School of Medicine, 1993
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Telehealth
Offers telehealth services
Group practices
Sharp Rees-Stealy Medical Group IncGroup PAC ID 8628972759, 872 clinicians

Practice addresses (Care Compare)

10243 Genetic Ctr Dr
San Diego, CA 92121-6310
Phone (858) 499-2600

Merit-based Incentive Payment System (MIPS)

Final score
88.67 of 100Reported as group
Quality
81.04
Promoting interoperability
99
Improvement activities
40
Cost
82.04

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
G 79877CAMDObstetrics & Gynecology Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Sharp Rees-Stealy Medical Group, Inc Obstetrics & Gynecology CurrentSince Jun 4, 2007 Accepting new patients
Sharp Rees-Stealy Medical Group, Inc CurrentSince Jun 4, 2007 Accepting new patients
Sharp Rees-Stealy Medical Center Past Accepting new patients
Sharp Memorial Hospital Past Accepting new patients
Sharp Memorial Hospital Past Accepting new patients
Rady Children'S Hospital San Diego Past Accepting new patients

Locations

10243 Genetic Center Dr
San Diego, CA 92121
Phone (858) 499-2704

2020 Genesee Ave
San Diego, CA 92123
Phone (619) 268-9500

8701 Cuyamaca St
Santee, CA 92071
Phone (619) 568-8025

Interoperability endpoints

  • Direct secure messaging: pdietze33210@sharphealthcare.direct-ci.com

Organizations & group practices 6

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

NPI Registry JSON

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

{
    "created_epoch": "1156896000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1371513600000",
    "number": "1336259290",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "10243 GENETIC CENTER DR",
            "city": "SAN DIEGO",
            "state": "CA",
            "postal_code": "921216310",
            "telephone_number": "858-499-2702",
            "fax_number": "858-526-6113"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "10243 GENETIC CENTER DR",
            "city": "SAN DIEGO",
            "state": "CA",
            "postal_code": "921216310",
            "telephone_number": "858-499-2702",
            "fax_number": "858-526-6113"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "DIETZE",
        "first_name": "PETER",
        "name_prefix": "Dr.",
        "name_suffix": "Jr.",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-08-30",
        "last_updated": "2013-06-18",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207V00000X",
            "taxonomy_group": "",
            "desc": "Obstetrics & Gynecology",
            "state": "CA",
            "license": "G 79877",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "00G 798770",
            "state": "CA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in San Diego, CA

Sources for this page

Verify at the official NPI Registry.