NPIMap

Individual provider Active NPI

Darrell R Pietsch, M.D.

  • Family Medicine Physician
  • Waco, TX
National Provider Identifier
1780689992
Registry record updated Jan 8, 2010
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Medicine PhysicianTaxonomy code 207Q00000X
License
K7867 Issued in TX
Practice address
6600 Fish Pond Rd Ste 202a
Waco, TX 76710-2582
Phone
(254) 732-6789
Fax
(254) 732-6790
NPI assigned
Jun 15, 2005
Last updated
Jan 8, 2010By the provider in NPPES
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jan 8, 2010

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Family Medicine Physician 207Q00000X K7867 TX Primary

Addresses

Primary practice location

6600 Fish Pond Rd Ste 202a
Waco, TX 76710-2582

Mailing address

6600 Fish Pond Rd Ste 202a
Waco, TX 76710-2582
Phone (254) 732-6789

Other identifiers 4

IdentifierTypeStateIssuer
8BZ212OtherTXBCBS
103631103MedicaidTX
8L10057OtherTXMEDICARE
103631105MedicaidTX

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in TX
Eligible to order & refer
  • Part B services
  • Medical equipment
  • Home health
  • Power mobility devices
  • Hospice
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20040308001121 TX Practitioner - Family Practice 2365330701 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Family Practice
Education
University of Texas Medical School at San Antonio, 1998
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Providence Health AllianceGroup PAC ID 6305731068, 119 clinicians

Practice addresses (Care Compare)

6600 Fish Pond Rd
Suite 202a
Waco, TX 76710-2582
Phone (254) 732-6789

Hospital & facility affiliations

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Doctor of Medicine

State licenses

LicenseStateTypeSpecialty
K7867TXMDFamily Medicine Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Providence Health Alliance CurrentSince Apr 1, 2009 Accepting new patients
Providence Health Alliance CurrentSince Apr 1, 2009 Accepting new patients
Coryell County Memorial Hospital Authority Past Accepting new patients
West Wharton County Hospital District Past Accepting new patients
Providence Park, Inc. Past Accepting new patients

Locations

301 Richland West Cir
Waco, TX 76712
Phone (254) 537-6200

6600 Fish Pond Rd
Ste 202A
Waco, TX 76710
Phone (254) 265-7300

6901 Medical Pkwy
Waco, TX 76712
Phone (254) 751-4000

Interoperability endpoints

  • Direct secure messaging: darrell.pietsch.1@9635.direct.athenahealth.com

Ownership & related parties

All facility ownership & control disclosures 2

Facilities whose Medicare enrollment lists this provider’s PECOS associate ID as an owner or managing party.

FacilityTypeRoleSince
Ascension Living Providence VillageWaco, TX, CCN 455983 Skilled nursing facility Operational/Managerial Control
Adp of the SNF		 Aug 1, 2017
Aug 1, 2017
Amedisys Hospice of San AntonioSan Antonio, TX, CCN 451738 Hospice Contracted Managing Employee Jan 1, 2025

Owned or controlled facilities with NPI records 2

Facilities whose Medicare enrollment lists this provider as an owner, officer, director or managing party.

Organizations & group practices 6

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.

Hospital & facility affiliations 4

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

NPI Registry JSON

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

{
    "created_epoch": "1118793600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1262908800000",
    "number": "1780689992",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "6600 FISH POND RD STE 202A",
            "city": "WACO",
            "state": "TX",
            "postal_code": "767102582",
            "telephone_number": "254-732-6789",
            "fax_number": "254-732-6790"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "6600 FISH POND RD STE 202A",
            "city": "WACO",
            "state": "TX",
            "postal_code": "767102582",
            "telephone_number": "254-732-6789",
            "fax_number": "254-732-6790"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "PIETSCH",
        "first_name": "DARRELL",
        "middle_name": "R",
        "name_prefix": "Dr.",
        "credential": "M.D.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2005-06-15",
        "last_updated": "2010-01-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "TX",
            "license": "K7867",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BCBS",
            "identifier": "8BZ212",
            "state": "TX"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "103631103",
            "state": "TX"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "MEDICARE",
            "identifier": "8L10057",
            "state": "TX"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "103631105",
            "state": "TX"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Waco, TX

Sources for this page

Verify at the official NPI Registry.