Alissa Anne Detz, MD

Primary specialty

Internal Medicine PhysicianTaxonomy code 207R00000X

License

A110966 Issued in CA

Practice address

200 Medical PLZ
420
Los Angeles, CA 90095-0001

Phone

(310) 794-9809

Fax

(310) 206-3551

NPI assigned

Mar 23, 2010

Last updated

Aug 31, 2012By the provider in NPPES

Sex

Female

Sole proprietor

No

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

Specialties & licenses 1

Addresses

Other identifiers 2

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: Yes

Green means eligible to order or refer.

Enrollment records 1

Specialty

Internal Medicine

Education

University of California, Irvine, California College of Medicine, 2008

Medicare assignment

May accept Medicare assignment

Group practices

Marin Community ClinicGroup PAC ID 0840108031, 28 clinicians

Practice addresses (Care Compare)

Hospital & facility affiliations

• Marinhealth Medical Center Hospital, Greenbrae, CA, CCN 050360

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Medicine

State licenses

Practice roles

Interoperability endpoints

• Direct secure messaging: adetz584912@direct.ochin.org

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.

• Marin Community Clinic

  • Federally Qualified Health Center (FQHC)
  • Novato, CA
  • NPI 1003900101
  Medicare reassignment Care Compare group
• Sutter Bay Hospitals

  dba California Pacific Medical Center - Mission Bernal Campus

  • General Acute Care Hospital
  • San Francisco, CA
  • NPI 1730238007
  NPD (past)

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

• Marin General Hospital

  • General Acute Care Hospital
  • Greenbrae, CA
  • NPI 1396725677
  Care Compare affiliation

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

{
    "created_epoch": "1269302400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1346371200000",
    "number": "1811211626",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "200 MEDICAL PLZ",
            "address_2": "420",
            "city": "LOS ANGELES",
            "state": "CA",
            "postal_code": "900950001",
            "telephone_number": "310-794-9809",
            "fax_number": "310-206-3551"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "200 MEDICAL PLZ",
            "address_2": "420",
            "city": "LOS ANGELES",
            "state": "CA",
            "postal_code": "900950001",
            "telephone_number": "310-794-9809",
            "fax_number": "310-206-3551"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "DETZ",
        "first_name": "ALISSA",
        "middle_name": "ANNE",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2010-03-23",
        "last_updated": "2012-08-31",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207R00000X",
            "taxonomy_group": "",
            "desc": "Internal Medicine",
            "state": "CA",
            "license": "A110966",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1811211626",
            "state": "CA"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "MEDI-CAL     CCS PANELED PROVIDER",
            "identifier": "1811211626",
            "state": "CA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Determined Medical Inc
• Detox Treatment Center
• Zephyr Detrano
• Jon A Detterich, MD
• Jina Vinh Dettman
• Erika Deuel, OTR/L
• Catherine Marin Deugarte, M.D.
• Daniel Alberto Deugarte, MD
• Grace Deukmedjian, M.D.
• Sabrina Marie Deulofeu

• Internal Medicine Physician in Los Angeles, CA
• Providers in Los Angeles, CA by specialty
• Internal Medicine Physician in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 31, 2012; 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.