Active NPI
Charles Joseph Dietzen, M.D.
- Pediatric Rehabilitation Medicine Physician
- Indianapolis, IN
National Provider Identifier
1790756385
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Pediatric Rehabilitation Medicine Physician
- License
- 01036773A
- Practice address
- 705 Riley Hospital Dr
Ri 3146
Indianapolis, IN 46202-5109 - Phone
- (317) 944-2353
- Fax
- (317) 944-2390
- NPI assigned
- Jan 31, 2006
- Sex
- Male
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Pediatric Rehabilitation Medicine Physician | 2081P0010X | 01036773A | IN | Primary |
Addresses
Primary practice location
705 Riley Hospital Dr
Ri 3146
Indianapolis, IN 46202-5109
Mailing address
PO Box 1026
Indianapolis, IN 46206-1026
Phone (317) 274-1201
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 100284930 | Medicaid | IN |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
- Credentials
- Doctor of Medicine
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Arch Advantage Foot and Ankle Center | Past | Accepting new patients | |
| Crossroads Rehabilitation Center, Inc. | Past | Accepting new patients | |
| Major Hospital | Past | Accepting new patients |
Interoperability endpoints
- https://fhir.meditouchehr.com/api/fhir/r4/
Organizations & group practices 3
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.
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- Indianapolis, IN
- NPI 1427899822
-
dba Easter Seals Crossroads
- Rehabilitation Practitioner
- Indianapolis, IN
- NPI 1457359838
-
- General Acute Care Hospital
- Shelbyville, IN
- NPI 1174555692
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1138665600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1387324800000",
"number": "1790756385",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "PO BOX 1026",
"city": "INDIANAPOLIS",
"state": "IN",
"postal_code": "462061026",
"telephone_number": "317-274-1201",
"fax_number": "317-278-9905"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "705 RILEY HOSPITAL DR",
"address_2": "RI 3146",
"city": "INDIANAPOLIS",
"state": "IN",
"postal_code": "462025109",
"telephone_number": "317-944-2353",
"fax_number": "317-944-2390"
}
],
"practiceLocations": [],
"basic": {
"last_name": "DIETZEN",
"first_name": "CHARLES",
"middle_name": "JOSEPH",
"credential": "M.D.",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2006-01-31",
"last_updated": "2013-12-18",
"status": "A"
},
"taxonomies": [
{
"code": "2081P0010X",
"taxonomy_group": "",
"desc": "Physical Medicine & Rehabilitation, Pediatric Rehabilitation Medicine",
"state": "IN",
"license": "01036773A",
"primary": true
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "100284930",
"state": "IN"
}
],
"endpoints": [],
"other_names": []
}Other providers in Indianapolis, IN
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 18, 2013; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.