NPIMap

Individual provider Active NPI

Jason Michael Dierking, M.D.

  • Surgery Physician
  • Storm Lake, IA
National Provider Identifier
1477675940
Registry record updated Oct 16, 2019
On this page

Key facts

NPPES NPI Registry
Primary specialty
Surgery PhysicianTaxonomy code 208600000X
License
37099 Issued in IA
Practice address
210 E 5TH St
Storm Lake, IA 50588-2342
Phone
(712) 213-4750
Fax
(712) 213-5230
NPI assigned
Apr 4, 2007
Last updated
Oct 16, 2019By the provider in NPPES
Sex
Male
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Oct 16, 2019

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Surgery Physician 208600000X 37099 IA Primary

Addresses

Primary practice location

210 E 5TH St
Storm Lake, IA 50588-2342

Mailing address

1525 W 5TH St
Storm Lake, IA 50588-3027
Phone (712) 213-4750

Other identifiers 1

IdentifierTypeStateIssuer
0786335MedicaidIA

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in IA
Eligible to order & refer
  • Part B services
  • Medical equipment
  • Home health
  • Power mobility devices
  • Hospice
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20070808000826 IA Practitioner - General Surgery 3274624093 Reassigns benefits to 2 organizations

Care Compare profile

Medicare Care Compare
Specialty
General Surgery
Education
University of Iowa, RJ & L Carver College of Medicine, 2002
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Buena Vista Regional Medical CenterGroup PAC ID 3476464421, shared by 4 NPIs, 25 clinicians

Practice addresses (Care Compare)

1525 W 5TH St
Storm Lake, IA 50588-3027
Phone (712) 732-4030

Hospital & facility affiliations

Merit-based Incentive Payment System (MIPS)

Final score
87.87 of 100Reported as individual
Quality
86.07
Promoting interoperability
94
Improvement activities
40
Cost
78.5

Procedures performed for Medicare patients

ProcedureNumber of procedures
Colonoscopy75
Hernia repair - groin (open)1-10
Mastectomy1-10
Upper gastrointestinal (GI) endoscopy for acid reflux37
Melanoma (skin cancer) excision13
Removal of tissue1-10
Skin biopsy1-10

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
37099IAMDSurgery Physician

Practice roles

OrganizationSpecialtyStatusNew patients
St Luke's Methodist Hospital Current Accepting new patients
Buena Vista Regional Medical Center Current Accepting new patients
Buena Vista Regional Medical Center Surgery CurrentSince Aug 14, 2017 Accepting new patients
Buena Vista Regional Medical Center CurrentSince Aug 14, 2017 Accepting new patients
Buena Vista Regional Medical Center Past Accepting new patients

Locations

1525 W 5th St
Storm Lake, IA 50588
Phone (712) 732-4030

210 E 5th St
Storm Lake, IA 50588
Phone (515) 712-4750

Interoperability endpoints

  • Direct secure messaging: jdierking158524@direct.unitypoint.org

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, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

Hospital & facility affiliations 5

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": "1175644800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1571184000000",
    "number": "1477675940",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1525 W 5TH ST",
            "city": "STORM LAKE",
            "state": "IA",
            "postal_code": "505883027",
            "telephone_number": "712-213-4750",
            "fax_number": "712-213-5230"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "210 E 5TH ST",
            "city": "STORM LAKE",
            "state": "IA",
            "postal_code": "505882342",
            "telephone_number": "712-213-4750",
            "fax_number": "712-213-5230"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "DIERKING",
        "first_name": "JASON",
        "middle_name": "MICHAEL",
        "name_prefix": "Dr.",
        "credential": "M.D.",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2007-04-04",
        "last_updated": "2019-10-16",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "208600000X",
            "taxonomy_group": "",
            "desc": "Surgery",
            "state": "IA",
            "license": "37099",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "0786335",
            "state": "IA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Storm Lake, IA

Sources for this page

Verify at the official NPI Registry.