Individual provider Active NPI

Deborah Gloria Baca-Dietz, NP

  • Family Nurse Practitioner
  • Salem, OR
National Provider Identifier
1780196220
Registry record updated Nov 27, 2023
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Nurse PractitionerTaxonomy code 363LF0000X
License
201708782NP-PP Issued in OR
Practice address
1233 Edgewater St NW
Salem, OR 97304
Phone
(503) 378-7526
NPI assigned
Oct 24, 2017
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Nov 27, 2023

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Family Nurse Practitioner 363LF0000X 201708782NP-PP OR Primary

Addresses

Primary practice location

1233 Edgewater St NW
Salem, OR 97304

Mailing address

1233 Edgewater St NW
Salem, OR 97304-4049
Phone (503) 378-7526

Electronic endpoints 1

TypeEndpointUseAffiliation
Direct Messaging Address debbie.bacadietz.p1@direct.nwhumanservices.nextgenshare.com Direct Northwest Human Services, Inc.

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in OR
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
I20180102002723 OR Practitioner - Nurse Practitioner 8628336245 Reassigns benefits to 1 organization

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
201708782NP-PPORMDFamily Nurse Practitioner

Practice roles

OrganizationSpecialtyStatusNew patients
DHS/Office of Financial Services Irs/Eopc/BMRC/Eotc/Osh/Osh-P CurrentSince Oct 18, 2024 Accepting new patients
Willamette Valley Hospice Inc PastSince Sep 23, 2023 Accepting new patients

Locations

2600 Center St NE
Salem, OR 97301
Phone (503) 945-2800

Interoperability endpoints

  • Direct secure messaging: debbie.bacadietz.p1@direct.nwhumanservices.nextgenshare.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": "1508803200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1701043200000",
    "number": "1780196220",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1233 EDGEWATER ST NW",
            "city": "SALEM",
            "state": "OR",
            "postal_code": "973044049",
            "telephone_number": "503-378-7526",
            "fax_number": "503-588-5815"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1233 EDGEWATER ST NW",
            "city": "SALEM",
            "state": "OR",
            "postal_code": "97304",
            "telephone_number": "503-378-7526"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "BACA-DIETZ",
        "first_name": "DEBORAH",
        "middle_name": "GLORIA",
        "credential": "NP",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2017-10-24",
        "last_updated": "2023-11-27",
        "certification_date": "2020-10-09",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LF0000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Family",
            "state": "OR",
            "license": "201708782NP-PP",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "debbie.bacadietz.p1@direct.nwhumanservices.nextgenshare.com",
            "affiliation": "Y",
            "affiliationName": "Northwest Human Services, Inc.",
            "use": "DIRECT",
            "useDescription": "Direct",
            "address_1": "1233 Edgewater St NW",
            "city": "Salem",
            "state": "OR",
            "country_code": "US",
            "postal_code": "973044049",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

Other providers in Salem, OR

Sources for this page

Verify at the official NPI Registry.