Individual provider Active NPI

Tracy Jo Irons-Dieterle, NP-C

  • Family Nurse Practitioner
  • Apple Valley, MN
National Provider Identifier
1386910479
Registry record updated Mar 1, 2017
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Nurse PractitionerTaxonomy code 363LF0000X
License
R 136630-3 Issued in MN
Practice address
15290 Pennock LN
Apple Valley, MN 55124-7163
Phone
(952) 853-8800
NPI assigned
Mar 22, 2012
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Mar 1, 2017

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Family Nurse Practitioner 363LF0000X R 136630-3 MN Primary

Addresses

Primary practice location

15290 Pennock LN
Apple Valley, MN 55124-7163

Mailing address

15290 Pennock LN
Apple Valley, MN 55124-7163
Phone (952) 652-3443

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in MN
Eligible to order & refer
  • Part B services: Yes
  • Medical equipment: Yes
  • Home health: Yes
  • Power mobility devices: Yes
  • Hospice: No
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20120614000754 MN Practitioner - Nurse Practitioner 4183888563 Reassigns benefits to 2 organizations

Care Compare profile

Medicare Care Compare
Specialty
Nurse Practitioner
Education
Other, 2011
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Northfield HospitalGroup PAC ID 2567372998, 121 clinicians

Practice addresses (Care Compare)

9974 214TH St W
Lakeville, MN 55044-1913
Phone (952) 469-0500

Hospital & facility affiliations

  • Northfield Hospital Hospital, Northfield, MN, CCN 240014

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Nurse Practitioner

State licenses

LicenseStateTypeSpecialty
R 136630-3MNMDFamily Nurse Practitioner

Practice roles

OrganizationSpecialtyStatusNew patients
Northfield Hospital CurrentSince Jan 15, 2024 Accepting new patients
Group Health, Inc. CurrentSince May 1, 2012 Accepting new patients
Group Health, Inc. Current Accepting new patients
Northfield Hospital Current Accepting new patients
Group Health, Inc. CurrentSince May 1, 2012 Accepting new patients

Locations

4645 Knutsen Dr
Farmington, MN 55024
Phone (651) 460-2300

9974 214th St W
Lakeville, MN 55044
Phone (952) 469-0500

8600 Nicollet Ave S
Minneapolis, MN 55420
Phone (952) 887-6600

2014 Jefferson Rd
Ste Cd
Northfield, MN 55057
Phone (507) 646-6700

2000 North Ave
Northfield, MN 55057
Phone (507) 646-1000

15290 Pennock Ln
Saint Paul, MN 55124
Phone (952) 431-8500

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.

Hospital & facility affiliations 1

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": "1332374400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1488326400000",
    "number": "1386910479",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "15290 PENNOCK LN",
            "city": "APPLE VALLEY",
            "state": "MN",
            "postal_code": "551247163",
            "telephone_number": "952-652-3443"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "15290 PENNOCK LN",
            "city": "APPLE VALLEY",
            "state": "MN",
            "postal_code": "551247163",
            "telephone_number": "952-853-8800"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "IRONS-DIETERLE",
        "first_name": "TRACY",
        "middle_name": "JO",
        "credential": "NP-C",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2012-03-22",
        "last_updated": "2017-03-01",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LF0000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Family",
            "state": "MN",
            "license": "R 136630-3",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Apple Valley, MN

Sources for this page

Verify at the official NPI Registry.