Individual provider Active NPI

Joseph W Diehl III, M.D.

  • MOHS-Micrographic Surgery Physician
  • SN Luis Obisp, CA
National Provider Identifier
1366731960
Registry record updated Dec 12, 2018
On this page

Key facts

NPPES NPI Registry
Primary specialty
MOHS-Micrographic Surgery PhysicianTaxonomy code 207ND0101X
License
A124317 Issued in CA
Practice address
15 Santa Rosa St
SN Luis Obisp, CA 93405-1811
Phone
(805) 541-2650
NPI assigned
Apr 4, 2011
Last updated
Dec 12, 2018By the provider in NPPES
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Dec 12, 2018

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

Specialties & licenses 3

Specialty (taxonomy)CodeLicenseStatePrimary
Student in an Organized Health Care Education/Training Program 390200000X NU
Dermatology Physician 207N00000X A124317 CA
MOHS-Micrographic Surgery Physician 207ND0101X A124317 CA Primary

Addresses

Primary practice location

15 Santa Rosa St
SN Luis Obisp, CA 93405-1811

Mailing address

15 Santa Rosa St
SN Luis Obisp, CA 93405-1811
Phone (805) 541-2650

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
I20150723007679 CA Practitioner - Dermatology 1850604570 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Dermatology
Education
Other, 2011
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
San Luis Dermatology, Inc.Group PAC ID 5496700767, 6 clinicians

Practice addresses (Care Compare)

15 Santa Rosa St
San Luis Obispo, CA 93405-1811
Phone (805) 541-2650

Hospital & facility affiliations

Merit-based Incentive Payment System (MIPS)

Final score
86.58 of 100Reported as group
Quality
96.73
Improvement activities
40
Cost
59.63

Procedures performed for Medicare patients

ProcedureNumber of procedures
Melanoma (skin cancer) excision123
Removal of tissue13
Removal of skin lesions7577
Removal of skin cancer1228
Removal or shaving of skin growth179
Skin biopsy842

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
A124317CAMDDermatology Physician

Practice roles

OrganizationSpecialtyStatusNew patients
San Luis Dermatology, Inc. Dermatology CurrentSince Sep 1, 2017 Accepting new patients
UCLA Medical Group Dermatology Past Accepting new patients
R Jeffrey Herten MD Inc Dermatology PastSince Sep 1, 2017 Accepting new patients

Locations

7544 Morro Rd
Atascadero, CA 93422
Phone (805) 464-2755

15 Santa Rosa St
Sn Luis Obisp, CA 93405
Phone (805) 541-2650

1551 Bishop St
Ste 410
Sn Luis Obisp, CA 93401
Phone (805) 541-4180

Organizations & group practices 3

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 2

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": "1301875200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1544572800000",
    "number": "1366731960",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "15 SANTA ROSA ST",
            "city": "SN LUIS OBISP",
            "state": "CA",
            "postal_code": "934051811",
            "telephone_number": "805-541-2650"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "15 SANTA ROSA ST",
            "city": "SN LUIS OBISP",
            "state": "CA",
            "postal_code": "934051811",
            "telephone_number": "805-541-2650"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "DIEHL",
        "first_name": "JOSEPH",
        "middle_name": "W",
        "name_prefix": "Dr.",
        "name_suffix": "III",
        "credential": "M.D.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2011-04-04",
        "last_updated": "2018-12-12",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "390200000X",
            "taxonomy_group": "",
            "desc": "Student in an Organized Health Care Education/Training Program",
            "state": "NU",
            "license": null,
            "primary": false
        },
        {
            "code": "207N00000X",
            "taxonomy_group": "",
            "desc": "Dermatology",
            "state": "CA",
            "license": "A124317",
            "primary": false
        },
        {
            "code": "207ND0101X",
            "taxonomy_group": "",
            "desc": "Dermatology, MOHS-Micrographic Surgery",
            "state": "CA",
            "license": "A124317",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in SN Luis Obisp, CA

Sources for this page

Verify at the official NPI Registry.