Spine Innovations, LLC

Primary specialty

SpecialistTaxonomy code 174400000X

License

MD.19033 Issued in LA

Legal business name

SPINE INNOVATIONS, LLC

Practice address

29301 N Dixie Ranch Rd
Lacombe, LA 70445-5403

Phone

(985) 871-4114

Fax

(985) 871-4130

NPI assigned

Mar 24, 2017

Last updated

Mar 24, 2017By the provider in NPPES

Organization subpart

No

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

Authorized official

Name

Dr. Donald D Dietze, M.D.NPI 1316913635

Title

Owner

Phone

(985) 871-4114

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Enrolled in LA

Enrollment records 1

These CMS records do not include an NPI. They are shown because their name and street address match this provider’s.

CLIA laboratory certificates

Practitioners 2

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

• Donald David Dietze Jr., MD

  • Neurological Surgery Physician
  • Lacombe, LA
  • NPI 1316913635
  Medicare reassignment NPD Authorized official
• Lorenzo Boykin Fisher, APRN, FNP-C

  • Nurse Practitioner
  • Lacombe, LA
  • NPI 1013983378
  Medicare reassignment NPD

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

{
    "created_epoch": "1490313600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1490313600000",
    "number": "1366973935",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "29301 N DIXIE RANCH RD",
            "city": "LACOMBE",
            "state": "LA",
            "postal_code": "704455403",
            "telephone_number": "985-871-4114",
            "fax_number": "985-871-4130"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "29301 N DIXIE RANCH RD",
            "city": "LACOMBE",
            "state": "LA",
            "postal_code": "704455403",
            "telephone_number": "985-871-4114",
            "fax_number": "985-871-4130"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "SPINE INNOVATIONS, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2017-03-24",
        "last_updated": "2017-03-24",
        "status": "A",
        "authorized_official_last_name": "DIETZE",
        "authorized_official_first_name": "DONALD",
        "authorized_official_middle_name": "D",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "985-871-4114",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "M.D."
    },
    "taxonomies": [
        {
            "code": "174400000X",
            "taxonomy_group": "",
            "desc": "Specialist",
            "state": "LA",
            "license": "MD.19033",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Sleep Solutions of Lacombe, L.L.C. (Center for Cardiac Sleep Medicine)
• Sleep Solutions of Lacombe, L.L.C. (Center for Cardiac Sleep Medicine)
• Smiling Faces of Lacombe LLC
• Jenna Cazayoux Smith, LOTR
• Southern Pain & Anesthesia Consultants, LLC
• Hallie Spooner, MD
• St Tammany Parish Fire Dist 3
• Amy St. Romain, P.T.
• Heather Stewart, HEATHER
• Tiffanie Stokes

• Specialist in Lacombe, LA
• Providers in Lacombe, LA by specialty
• Specialist in Louisiana

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 24, 2017; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.