Individual provider Active NPI

David K De Dianous, MD

  • Physical Medicine & Rehabilitation Physician
  • La Crosse, WI
National Provider Identifier
1386695815
Registry record updated Jan 14, 2025
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physical Medicine & Rehabilitation PhysicianTaxonomy code 208100000X
License
34618-20 Issued in WI
Practice address
700 West Ave S
La Crosse, WI 54601-4783
Phone
(608) 785-0940
NPI assigned
May 12, 2006
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jan 14, 2025

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Physical Medicine & Rehabilitation Physician 208100000X 34618-20 WI Primary

Addresses

Primary practice location

700 West Ave S
La Crosse, WI 54601-4783

Mailing address

200 1St St SW
Rochester, MN 55905-0001
Phone (414) 955-7199

Other identifiers 2

IdentifierTypeStateIssuer
1386695815MedicaidWI
004006261QOtherHUMANA

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in WI
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
I20060404000525 WI Practitioner - Physical Medicine and Rehabilitation 6406864396 Reassigns benefits to 3 organizations

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
34618-20WIMDPhysical Medicine & Rehabilitation Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Mayo Clinic Health System-Southwest Wisconsin Region, Inc. CurrentSince Apr 27, 2022 Accepting new patients
Froedtert &the Medical College of Wisconsin Community Physicians, Inc. CurrentSince Jan 24, 2017 Accepting new patients
Froedtert &the Medical College of Wisconsin Community Physicians, Inc. CurrentSince Jan 24, 2017 Accepting new patients
Mayo Clinic Health System-Southwest Wisconsin Region, Inc. CurrentSince Apr 27, 2022 Accepting new patients

Locations

200 1st St SW
Rochester, MN 55905
Phone (507) 266-4850

W168N11237 Western Ave
Germantown, WI 53022
Phone (262) 253-5060

700 West Ave S
La Crosse, WI 54601
Phone (608) 791-4156

800 E Blackhawk Ave
Prairie du Chien, WI 53821
Phone (608) 326-0808

8701 Watertown Plank Rd
Wauwatosa, WI 53226
Phone (414) 456-4100

1155 N Mayfair Rd
Wauwatosa, WI 53226
Phone (414) 955-5990

840 N 87th St
Wauwatosa, WI 53226
Phone (414) 805-5540

Organizations & group practices 5

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": "1147392000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1736812800000",
    "number": "1386695815",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "200 1ST ST SW",
            "city": "ROCHESTER",
            "state": "MN",
            "postal_code": "559050001",
            "telephone_number": "414-955-7199"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "700 WEST AVE S",
            "city": "LA CROSSE",
            "state": "WI",
            "postal_code": "546014783",
            "telephone_number": "608-785-0940"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "DE DIANOUS",
        "first_name": "DAVID",
        "middle_name": "K",
        "name_prefix": "Dr.",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-05-12",
        "last_updated": "2025-01-14",
        "certification_date": "2025-01-14",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "208100000X",
            "taxonomy_group": "",
            "desc": "Physical Medicine & Rehabilitation",
            "state": "WI",
            "license": "34618-20",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1386695815",
            "state": "WI"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "HUMANA",
            "identifier": "004006261Q",
            "state": null
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in La Crosse, WI

Sources for this page

Verify at the official NPI Registry.