Richard Edward Dietzen, M.D.

Primary specialty

SpecialistTaxonomy code 174400000X

License

E-1069 Issued in AR

Practice address

403 W Oak St
Suite 302
El Dorado, AR 71730-4586

Phone

(870) 863-6444

Fax

(870) 863-6675

NPI assigned

Oct 5, 2005

Last updated

Oct 27, 2010By the provider in NPPES

Sex

Male

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 AR

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

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Medicine

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.

• Richard E. Dietzen, M.D.,P.a.

  • Medical Specialty Clinic/Center
  • El Dorado, AR
  • NPI 1174738397
  Authorized official Same address or phone

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

{
    "created_epoch": "1128470400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1288137600000",
    "number": "1871580704",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 2116",
            "city": "EL DORADO",
            "state": "AR",
            "postal_code": "717312116",
            "telephone_number": "870-863-6444",
            "fax_number": "870-863-6675"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "403 W OAK ST",
            "address_2": "SUITE 302",
            "city": "EL DORADO",
            "state": "AR",
            "postal_code": "717304586",
            "telephone_number": "870-863-6444",
            "fax_number": "870-863-6675"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "DIETZEN",
        "first_name": "RICHARD",
        "middle_name": "EDWARD",
        "credential": "M.D.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2005-10-05",
        "last_updated": "2010-10-27",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "174400000X",
            "taxonomy_group": "",
            "desc": "Specialist",
            "state": "AR",
            "license": "E-1069",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "130492001",
            "state": "AR"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "136119002",
            "state": "AR"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Debra Faulkner (Port X Medical Services)
• Debra Faulkner (Portable Imaging)
• Jacob A Defee, LPC
• Peggy A Defoure
• Joseph A Deluca, MD
• Rebekah Marie Dixon, LCSW
• Rodney M. Dixon, M.D.
• Harvinder S Dod, MD
• Michael O Dodd, MS
• Ashley Louise Dodson

• Specialist in El Dorado, AR
• Providers in El Dorado, AR by specialty
• Specialist in Arkansas

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 27, 2010; 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.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.