NPIMap

Individual provider Active NPI

Cory Lynn Dietz, MD

  • Family Medicine Physician
  • Woodland Park, CO
National Provider Identifier
1508825753
Registry record updated Feb 19, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Medicine PhysicianTaxonomy code 207Q00000X
License
DR.0053528 Issued in CO
Practice address
700 W US Highway 24
Woodland Park, CO 80863-8975
Phone
(719) 522-1133
NPI assigned
Mar 17, 2006
Last updated
Feb 19, 2024By the provider in NPPES
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Feb 19, 2024

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Family Medicine Physician 207Q00000X 28289 IA
Family Medicine Physician 207Q00000X DR.0053528 CO Primary

Addresses

Primary practice location

700 W US Highway 24
Woodland Park, CO 80863-8975

Mailing address

2 S Cascade Ave Ste 140
Colorado Springs, CO 80903-1604
Phone (719) 538-2900

Other identifiers 2

IdentifierTypeStateIssuer
28530250MedicaidCO
3064089MedicaidIA

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in CO
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
I20160107000750 CO Practitioner - Family Practice 1153491568 Reassigns benefits to 2 organizations

Care Compare profile

Medicare Care Compare
Specialty
Family Practice
Education
Other, 1990
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices

Practice addresses (Care Compare)

1400 E Boulder
Colorado Springs, CO 80909-5533
Phone (719) 776-5000

Hospital & facility affiliations

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
DR.0053528COMDFamily Medicine Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Optumcare Colorado Medical Group LLC Current Accepting new patients
Optumcare Colorado Medical Group, LLC CurrentSince Oct 10, 2022 Accepting new patients
Peak Vista Community Health Centers CurrentSince Sep 1, 2024 Accepting new patients
Peak Vista Community Health Centers CurrentSince Sep 1, 2024 Accepting new patients
Optumcare Colorado Medical Group LLC CurrentSince Oct 10, 2022 Accepting new patients
Peak Vista Community Health Centers Past Accepting new patients
Dubuque Family Practice, PC Family Medicine Past Accepting new patients
Lettman Chiropractic Rehab Care Past Accepting new patients

Locations

1400 E Boulder St
Colorado Springs, CO 80909
Phone (719) 365-5120

1625 Medical Center Pt
Ste 290
Colorado Springs, CO 80907
Phone (719) 635-5148

2 S Cascade Ave
Ste 140
Colorado Springs, CO 80903
Phone (719) 538-2900

3205 N Academy Blvd
Ste 130
Colorado Springs, CO 80917
Phone (719) 344-6873

350 Lyckman Pl
Fountain, CO 80817
Phone (719) 491-5900

700 W US Highway 24
Woodland Park, CO 80863
Phone (719) 687-6022

Interoperability endpoints

  • Direct secure messaging: cory.dietz.p1@direct.peakvista.nextgenshare.com

Organizations & group practices 8

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 18

Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.

View all 18

NPI Registry JSON

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

{
    "created_epoch": "1142553600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1708300800000",
    "number": "1508825753",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2 S CASCADE AVE STE 140",
            "city": "COLORADO SPRINGS",
            "state": "CO",
            "postal_code": "809031604",
            "telephone_number": "719-538-2900",
            "fax_number": "719-538-2907"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "700 W US HIGHWAY 24",
            "city": "WOODLAND PARK",
            "state": "CO",
            "postal_code": "808638975",
            "telephone_number": "719-522-1133"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "DIETZ",
        "first_name": "CORY",
        "middle_name": "LYNN",
        "name_prefix": "Dr.",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-03-17",
        "last_updated": "2024-02-19",
        "certification_date": "2024-02-19",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "IA",
            "license": "28289",
            "primary": false
        },
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "CO",
            "license": "DR.0053528",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "28530250",
            "state": "CO"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "3064089",
            "state": "IA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Woodland Park, CO

Sources for this page

Verify at the official NPI Registry.