Charles L Dietzek, D.O.

Primary specialty

Vascular Surgery PhysicianTaxonomy code 2086S0129X

License

MB46719 Issued in NJ

Practice address

1101 White Horse Rd
Suite C
Voorhees, NJ 08043-2157

Phone

(856) 309-9777

NPI assigned

Aug 18, 2006

Last updated

May 29, 2018By the provider in NPPES

Sex

Male

Sole proprietor

No

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

Specialties & licenses 1

Addresses

Other identifiers 1

Medicare fee-for-service enrollment

Enrolled in NJ

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

Specialty

Vascular Surgery

Education

New York College of Osteo Medicine of New York Institute of Technology, 1983

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

Charles L Dietzek, DO, Facos, PCGroup PAC ID 0143256792, 2 clinicians

Practice addresses (Care Compare)

Hospital & facility affiliations

• Jefferson Stratford Hospital Hospital, Stratford, NJ, CCN 310086
• Kessler Institute for Rehabilitation,Inc Inpatient rehabilitation facility, Marlton, NJ, CCN 313032

Merit-based Incentive Payment System (MIPS)

Final score

100 of 100Reported as individual

Quality

100

Improvement activities

40

Procedures performed for Medicare patients

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Osteopathy

State licenses

Practice roles

Locations

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.

• Charles L Dietzek, DO, Facos, PC

  • Vascular Surgery Physician
  • Voorhees, NJ
  • NPI 1306905658
  Medicare reassignment Care Compare group NPD
• Charles L. Dietzek

  • Vascular Surgery Physician
  • Sewell, NJ
  • NPI 1861545188
  NPD (past)

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

• Kennedy University Hospital Inc.

  • General Acute Care Hospital
  • Stratford, NJ
  • NPI 1386746592
  Care Compare affiliation
• Kessler Institute for Rehabilitation, Inc.

  • Rehabilitation Hospital
  • Marlton, NJ
  • NPI 1528512266

  Inpatient rehabilitation facility

  Care Compare affiliation

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

{
    "created_epoch": "1155859200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1527552000000",
    "number": "1639283344",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1101 WHITE HORSE RD",
            "address_2": "SUITE C",
            "city": "VOORHEES",
            "state": "NJ",
            "postal_code": "080432157",
            "telephone_number": "856-309-9777"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1101 WHITE HORSE RD",
            "address_2": "SUITE C",
            "city": "VOORHEES",
            "state": "NJ",
            "postal_code": "080432157",
            "telephone_number": "856-309-9777"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "DIETZEK",
        "first_name": "CHARLES",
        "middle_name": "L",
        "credential": "D.O.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-08-18",
        "last_updated": "2018-05-29",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "2086S0129X",
            "taxonomy_group": "",
            "desc": "Surgery, Vascular Surgery",
            "state": "NJ",
            "license": "MB46719",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "0375209",
            "state": "NJ"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Karlene Marie Dibeneditto, CRNA
• Anthony D Dibona Jr., DO
• Anna Dicarlo, M.D.
• Ninetta Simone Dickerson, NNP
• Stephen Jay Dickstein, DPM
• Erika B Dietzek, APN (NP)
• Justina Dieujuste, MSN, APRN, PMHNP-BC
• Andrea F Digaetano, M.D.
• Anthony Joseph Dilolle, MOT
• Gisele S Dinatale, MA

• Vascular Surgery Physician in Voorhees, NJ
• Providers in Voorhees, NJ by specialty
• Vascular Surgery Physician in New Jersey

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 29, 2018; 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.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.