NPIMap

Organization Active NPI

Ryan S. Diederich, MD PC

Doing business as MidAmerica Plastic Surgery

  • Plastic and Reconstructive Surgery Physician
  • Glen Carbon, IL
National Provider Identifier
1639817182
Registry record updated May 24, 2022
On this page

Key facts

NPPES NPI Registry
Primary specialty
Plastic and Reconstructive Surgery PhysicianTaxonomy code 2086S0122X
Legal business name
RYAN S. DIEDERICH, MD PC
Doing business as
MidAmerica Plastic Surgery
Practice address
4955 S State Route 159 # 1
Glen Carbon, IL 62034-1907
Phone
(618) 288-7855
Fax
(618) 288-7866
NPI assigned
May 24, 2022
Last updated
May 24, 2022By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on May 24, 2022

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

Authorized official

Name
Ryan S Diederich, MDNPI 1942422498
Title
Owner
Phone
(618) 288-7855

Authorized official NPPES reports the official by name only. The link goes to the one practitioner with that name whose NPPES practice address or phone number is this organization’s.

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Plastic and Reconstructive Surgery Physician 2086S0122X NU Primary

Addresses

Primary practice location

4955 S State Route 159 # 1
Glen Carbon, IL 62034-1907

Mailing address

4955 S State Route 159 # 1
Glen Carbon, IL 62034-1907
Phone (618) 288-7855

Other names 1

  • MidAmerica Plastic Surgery Doing business as

National Provider Directory

National Provider Directory

Practitioners & affiliated clinicians

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

NPI Registry JSON

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

{
    "created_epoch": "1653350400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1653350400000",
    "number": "1639817182",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4955 S STATE ROUTE 159 # 1",
            "city": "GLEN CARBON",
            "state": "IL",
            "postal_code": "620341907",
            "telephone_number": "618-288-7855",
            "fax_number": "618-288-7866"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4955 S STATE ROUTE 159 # 1",
            "city": "GLEN CARBON",
            "state": "IL",
            "postal_code": "620341907",
            "telephone_number": "618-288-7855",
            "fax_number": "618-288-7866"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "RYAN S. DIEDERICH, MD PC",
        "organizational_subpart": "NO",
        "enumeration_date": "2022-05-24",
        "last_updated": "2022-05-24",
        "certification_date": "2022-05-24",
        "status": "A",
        "authorized_official_last_name": "DIEDERICH",
        "authorized_official_first_name": "RYAN",
        "authorized_official_middle_name": "S",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "618-288-7855",
        "authorized_official_credential": "MD"
    },
    "taxonomies": [
        {
            "code": "2086S0122X",
            "taxonomy_group": "",
            "desc": "Surgery, Plastic and Reconstructive Surgery",
            "state": "NU",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "MidAmerica Plastic Surgery",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Glen Carbon, IL

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 24, 2022; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.