Ian Diener, MD

Primary specialty

Family Medicine PhysicianTaxonomy code 207Q00000X

License

MD013520E Issued in PA

Practice address

102 Kitchens LN
Pocono Lake, PA 18347-7955

Phone

(570) 643-1650

NPI assigned

Feb 18, 2013

Sex

Male

Sole proprietor

Yes

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

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Enrolled in PA

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

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Medicine

State licenses

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

{
    "created_epoch": "1361145600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1361145600000",
    "number": "1609116359",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "102 KITCHENS LN",
            "city": "POCONO LAKE",
            "state": "PA",
            "postal_code": "183477955",
            "telephone_number": "570-643-1650"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "102 KITCHENS LN",
            "city": "POCONO LAKE",
            "state": "PA",
            "postal_code": "183477955",
            "telephone_number": "570-643-1650"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "DIENER",
        "first_name": "IAN",
        "name_prefix": "Dr.",
        "credential": "MD",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2013-02-18",
        "last_updated": "2013-02-18",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "PA",
            "license": "MD013520E",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• American Lifts and Service
• Deborah A Beiter, MD
• Sara J. Cornell, PSY.D.
• Frank Davis
• Monica Dawn Dickinson
• Colleen Anne Donahue, BCBA
• Blanche Howard, B.A., C.C.H.
• Christina Lascala, LPN
• Christine Lauff
• Mt. Pocono Family Practice Center

• Family Medicine Physician in Pocono Lake, PA
• Providers in Pocono Lake, PA by specialty
• Family Medicine Physician in Pennsylvania

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 18, 2013; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.