Susan K Retzlaff Deitrick, PA-C

Primary specialty

Physician AssistantTaxonomy code 363A00000X

License

829 Issued in NE

Practice address

418 N Webb Rd
Grand Island, NE 68803-4045

Phone

(308) 382-1100

Fax

(308) 385-0796

NPI assigned

Jul 29, 2005

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 NE

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, 1998

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

Grand Island Dermatology PCGroup PAC ID 0244284768, 9 clinicians

Practice addresses (Care Compare)

Hospital & facility affiliations

• The Nebraska Medical Center Hospital, Omaha, NE, CCN 280013

Merit-based Incentive Payment System (MIPS)

Final score

96.6 of 100Reported as group

Promoting interoperability

96

Improvement activities

40

Medicare enrollment (NPD)

Enrolled

Credentials

Physician Assistant

Practice roles

Interoperability endpoints

• Direct secure messaging: sdeitrick@giderm.emadirect.md

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.

• Grand Island Dermatology PC

  • Dermatology Physician
  • Grand Island, NE
  • NPI 1609836535
  Medicare reassignment Care Compare group
• Grand Island Clinic Inc

  • Clinical Medical Laboratory
  • Grand Island, NE
  • NPI 1003061912
  NPD (past)

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

• The Nebraska Medical Center

  • General Acute Care Hospital
  • Omaha, NE
  • NPI 1356307581
  Care Compare affiliation

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

{
    "created_epoch": "1122595200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1581638400000",
    "number": "1912907981",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 5436",
            "city": "GRAND ISLAND",
            "state": "NE",
            "postal_code": "688025436",
            "telephone_number": "308-384-9300",
            "fax_number": "484-359-8909"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "418 N WEBB RD",
            "city": "GRAND ISLAND",
            "state": "NE",
            "postal_code": "688034045",
            "telephone_number": "308-382-1100",
            "fax_number": "308-385-0796"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "RETZLAFF DEITRICK",
        "first_name": "SUSAN",
        "middle_name": "K",
        "credential": "PA-C",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2005-07-29",
        "last_updated": "2020-02-14",
        "certification_date": "2020-02-14",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "NE",
            "license": "829",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BCBS OF NE",
            "identifier": "37315",
            "state": "NE"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "100250168",
            "state": "NE"
        }
    ],
    "endpoints": [],
    "other_names": []
}

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• Physician Assistant in Grand Island, NE
• Providers in Grand Island, NE by specialty
• Physician Assistant in Nebraska

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 14, 2020; 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.