Deanna Nicole Dietrich, PA-C

Primary specialty

Physician AssistantTaxonomy code 363A00000X

License

PA.0007617 Issued in CO

Practice address

501 Hannibal St
Fulton, NY 13069-1015

Phone

(315) 887-1059

NPI assigned

Nov 15, 2022

Sex

Female

Sole proprietor

No

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

Specialties & licenses 4

Addresses

Medicare fee-for-service enrollment

Enrolled in CO

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

Specialty

Physician Assistant

Education

Other, 2022

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

Nadora Urgent Care, LLCGroup PAC ID 9335688860, 8 clinicians

Practice addresses (Care Compare)

Merit-based Incentive Payment System (MIPS)

Final score

93.04 of 100Reported as group

Quality

87.35

Promoting interoperability

100

Improvement activities

40

Merit-based Incentive Payment System (MIPS)

Final score

85.39 of 100Reported as group

Quality

74.12

Promoting interoperability

100

Improvement activities

40

Cost

77.17

Medicare enrollment (NPD)

Enrolled

Credentials

Physician Assistant

State licenses

Practice roles

Locations

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

• Nadora Urgent Care, LLC

  • Urgent Care Clinic/Center
  • Greeley, CO
  • NPI 1285462200

  CO

  Medicare reassignment Care Compare group NPD
• Emergency Physicians of the Rockies, PC

  • Emergency Medicine Physician
  • Ft Collins, CO
  • NPI 1174570717

  CO, Emergency Medicine

  Medicare reassignment NPD
• Anywhere Clinic LLC

  • Psychiatry Physician
  • Las Vegas, NV
  • NPI 1316460850

  CO

  Medicare reassignment
• Emergency Professionals of Colorado, PC

  • Emergency Medicine Physician
  • Loveland, CO
  • NPI 1396496469

  CO

  Medicare reassignment

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

{
    "created_epoch": "1668470400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1723680000000",
    "number": "1891404232",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "501 HANNIBAL ST",
            "city": "FULTON",
            "state": "NY",
            "postal_code": "130691015",
            "telephone_number": "315-887-1059"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "501 HANNIBAL ST",
            "city": "FULTON",
            "state": "NY",
            "postal_code": "130691015",
            "telephone_number": "315-887-1059"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "DIETRICH",
        "first_name": "DEANNA",
        "middle_name": "NICOLE",
        "credential": "PA-C",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2022-11-15",
        "last_updated": "2024-08-15",
        "certification_date": "2024-08-15",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "FL",
            "license": "PA9116592",
            "primary": false
        },
        {
            "code": "207P00000X",
            "taxonomy_group": "",
            "desc": "Emergency Medicine",
            "state": "FL",
            "license": "PA9116592",
            "primary": false
        },
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "NY",
            "license": "031818-01",
            "primary": false
        },
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "CO",
            "license": "PA.0007617",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Marie-Jeanne Desravines, M.D.
• Tiffany Marie Devendorf, LMSW
• David R Devito, D.D.S.
• Chalet Dewey-Flint, LCSW-R
• Michael R Diaz, D.O.
• Charlene Marie Dingman, LPN
• Tracy L Dingman, RPH
• Ben Phong DO, RPH
• Marina Danielle Donaghue, MHC-LP
• Casey Owen Donovan

• All providers in Fulton, NY
• Physician Assistant in New York

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 15, 2024; 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.