Active NPI
Heather Jean Dietz, PA-C
- Physician Assistant
- Boise, ID
National Provider Identifier
1346381639
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Physician Assistant
- License
- PA565
- Practice address
- 420 W Main St
Suite 203
Boise, ID 83702 - Phone
- (208) 429-1627
- Fax
- (208) 344-2104
- NPI assigned
- Feb 9, 2007
- Last updated
- Jul 21, 2022
- Sex
- Female
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Physician Assistant | 363A00000X | PA565 | ID | Primary |
Addresses
Primary practice location
420 W Main St
Suite 203
Boise, ID 83702
Mailing address
420 W Main St
Suite 203
Boise, ID 83702
Phone (208) 429-1627
Other identifiers 2
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 000010151786 | Other | ID | BLUE SHIELD NON-PAR PIN |
| PAYF0 | Other | ID | BLUE CROSS NON-PAR PIN |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
- Eligible to order & refer
- Part B services: Yes
- Medical equipment: Yes
- Home health: Yes
- Power mobility devices: Yes
- Hospice: No
- Opted out of Medicare
- Yes, effective Jan 1, 2015 through Jan 1, 2027
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
- Credentials
- Physician Assistant
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| PA565 | ID | MD | Physician Assistant |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1170979200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1658361600000",
"number": "1346381639",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "420 W MAIN ST",
"address_2": "SUITE 203",
"city": "BOISE",
"state": "ID",
"postal_code": "83702",
"telephone_number": "208-429-1627",
"fax_number": "208-344-2104"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "420 W MAIN ST",
"address_2": "SUITE 203",
"city": "BOISE",
"state": "ID",
"postal_code": "83702",
"telephone_number": "208-429-1627",
"fax_number": "208-344-2104"
}
],
"practiceLocations": [],
"basic": {
"last_name": "DIETZ",
"first_name": "HEATHER",
"middle_name": "JEAN",
"credential": "PA-C",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2007-02-09",
"last_updated": "2022-07-21",
"status": "A"
},
"taxonomies": [
{
"code": "363A00000X",
"taxonomy_group": "",
"desc": "Physician Assistant",
"state": "ID",
"license": "PA565",
"primary": true
}
],
"identifiers": [
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "BLUE SHIELD NON-PAR PIN",
"identifier": "000010151786",
"state": "ID"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "BLUE CROSS NON-PAR PIN",
"identifier": "PAYF0",
"state": "ID"
}
],
"endpoints": [],
"other_names": []
}Other providers in Boise, ID
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 21, 2022; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring; Opt Out Affidavits.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.