Individual provider Active NPI

Cheryl Anne Dietly

  • Psychiatric/Mental Health Nurse Practitioner
  • Ponte Vedra Beach, FL
National Provider Identifier
1649758756
Registry record updated May 13, 2022
On this page

Key facts

NPPES NPI Registry
Primary specialty
Psychiatric/Mental Health Nurse PractitionerTaxonomy code 363LP0808X
License
ARNP9337309 Issued in FL
Practice address
400 Colonnade Dr Ste 230
Ponte Vedra Beach, FL 32081-6236
Phone
(904) 376-3800
NPI assigned
Jul 31, 2018
Last updated
May 13, 2022By the provider in NPPES
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on May 13, 2022

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Psychiatric/Mental Health Nurse Practitioner 363LP0808X ARNP9337309 FL Primary

Addresses

Primary practice location

400 Colonnade Dr Ste 230
Ponte Vedra Beach, FL 32081-6236

Mailing address

PO Box 748519
Atlanta, GA 30374-8519
Phone (904) 376-3800

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in FL
Eligible to order & refer
  • Part B services: Yes
  • Medical equipment: Yes
  • Home health: Yes
  • Power mobility devices: Yes
  • Hospice: No
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20181218000778 FL Practitioner - Nurse Practitioner 9436494507 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Nurse Practitioner
Education
Other, 2018
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Telehealth
Offers telehealth services
Group practices
Baptist Behavioral Health LLCGroup PAC ID 7315166394, 120 clinicians

Practice addresses (Care Compare)

400 Colonnade Dr
Suite 230
Ponte Vedra, FL 32081-6237
Phone (904) 376-3800

Merit-based Incentive Payment System (MIPS)

Final score
89.95 of 100Reported as group
Quality
84.69
Promoting interoperability
100
Improvement activities
40
Cost
74.91

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Nurse Practitioner

State licenses

LicenseStateTypeSpecialty
ARNP9337309FLMDPsychiatric/Mental Health Nurse Practitioner

Practice roles

OrganizationSpecialtyStatusNew patients
Baptist Behavioral Health, LLC CurrentSince Oct 1, 2018 Accepting new patients
Southern Baptist Hospital of Florida Inc Past Accepting new patients

Locations

820 Prudential Dr
Ste 510
Jacksonville, FL 32207

3650 NW Devane St
Lake City, FL 32055
Phone (386) 755-1221

400 Colonnade Dr
Ste 230
Ponte Vedra Beach, FL 32081
Phone (904) 202-1795

87010 Professional Way
Yulee, FL 32097

Interoperability endpoints

  • Direct secure messaging: cdietly21026@baptisthealthsystemjacksonville.direct-ci.com

Organizations & group practices 2

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.

NPI Registry JSON

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

{
    "created_epoch": "1532995200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1652400000000",
    "number": "1649758756",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 748519",
            "city": "ATLANTA",
            "state": "GA",
            "postal_code": "303748519",
            "telephone_number": "904-376-3800",
            "fax_number": "904-376-3998"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "400 COLONNADE DR STE 230",
            "city": "PONTE VEDRA BEACH",
            "state": "FL",
            "postal_code": "320816236",
            "telephone_number": "904-376-3800"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "DIETLY",
        "first_name": "CHERYL",
        "middle_name": "ANNE",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2018-07-31",
        "last_updated": "2022-05-13",
        "certification_date": "2022-05-13",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LP0808X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Psychiatric/Mental Health",
            "state": "FL",
            "license": "ARNP9337309",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Ponte Vedra Beach, FL

Sources for this page

Verify at the official NPI Registry.