Alisa Michelle Dieterich, R.N. M.S.N. F.N.P.

Primary specialty

Nurse PractitionerTaxonomy code 363L00000X

License

NP18158 Issued in CA

Practice address

11333 Prospect Drive
Martell, CA 95654

Phone

(209) 268-0560

Fax

(209) 214-6946

NPI assigned

Jul 22, 2008

Last updated

Feb 11, 2022By the provider in NPPES

Sex

Female

Sole proprietor

Yes

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

Specialties & licenses 1

Addresses

Electronic endpoints 1

Medicare fee-for-service enrollment

Enrolled in CA

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

Specialty

Nurse Practitioner

Education

Other, 2008

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

Regents of the Univ of CaGroup PAC ID 3375456619, 1,571 clinicians

Practice addresses (Care Compare)

Hospital & facility affiliations

• University of California Davis Medical Center Hospital, Sacramento, CA, CCN 050599

Merit-based Incentive Payment System (MIPS)

Final score

83.15 of 100Reported as group

Quality

64.8

Promoting interoperability

100

Improvement activities

40

Cost

68.65

Medicare enrollment (NPD)

Enrolled

Credentials

Master of Science - Nursing, Nurse Practitioner, Registered Nurse

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.

• Regents of the Univ of Ca

  • Maternal & Fetal Medicine Physician
  • Sacramento, CA
  • NPI 1013906973
  Medicare reassignment Care Compare group NPD
• Permanente Medical Group Inc

  • Internal Medicine Physician
  • Santa Clara, CA
  • NPI 1073606299
  Medicare reassignment NPD
• Permanente Medical Group Inc

  • Internal Medicine Physician
  • Stockton, CA
  • NPI 1548343510
  NPD
• Regents of the Univ of Ca

  • Dermatology Physician
  • Sacramento, CA
  • NPI 1184617102
  NPD
• Regents of the Univ of Ca

  • Surgery Physician
  • Sacramento, CA
  • NPI 1427041698
  NPD (past)
• Regents of the Univ of Ca

  • Pulmonary Disease Physician
  • Sacramento, CA
  • NPI 1437142692
  NPD (past)

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

• Regents of the University of California

  dba University of California Davis Medical Center

  • General Acute Care Hospital
  • Sacramento, CA
  • NPI 1710918545
  Care Compare affiliation

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

{
    "created_epoch": "1216684800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1644537600000",
    "number": "1760647465",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "967 BIG SUR CT",
            "city": "EL DORADO HILLS",
            "state": "CA",
            "postal_code": "957624508",
            "telephone_number": "707-486-2672"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "11333 PROSPECT DRIVE",
            "city": "MARTELL",
            "state": "CA",
            "postal_code": "95654",
            "telephone_number": "209-268-0560",
            "fax_number": "209-214-6946"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "DIETERICH",
        "first_name": "ALISA",
        "middle_name": "MICHELLE",
        "credential": "R.N. M.S.N. F.N.P.",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2008-07-22",
        "last_updated": "2022-02-11",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363L00000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner",
            "state": "CA",
            "license": "NP18158",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [
        {
            "endpointType": "SOAP",
            "endpointTypeDescription": "SOAP URL",
            "endpoint": "https://careepicwest.kp.org:14430/Interconnect-prodcalgateway/wcf/epic.community.hie/xcpdrespondinggatewaysync.svc/ncalceq",
            "affiliation": "Y",
            "endpointDescription": "Carequality",
            "affiliationName": "The Permanente Medical Group",
            "use": "HIE",
            "useDescription": "Health Information Exchange (HIE)",
            "contentType": "OTHER",
            "contentTypeDescription": "Other",
            "contentOtherDescription": "C-CDA",
            "address_1": "1650 Eureka Rd",
            "city": "Roseville",
            "state": "CA",
            "country_code": "US",
            "postal_code": "95661",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

• Wellspace Health

• Nurse Practitioner in Martell, CA
• Providers in Martell, CA by specialty
• Nurse Practitioner in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 11, 2022; 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.