Thomas J Dietrich, M.D.

Primary specialty

Emergency Medicine PhysicianTaxonomy code 207P00000X

License

44609-020 Issued in WI

Practice address

111 E Wisconsin Ave
Suite 2000
Milwaukee, WI 53202-4815

Phone

(414) 290-6720

Fax

(414) 290-6755

NPI assigned

May 16, 2006

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 4

Medicare fee-for-service enrollment

Enrolled in WI

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

Emergency Medicine

Education

Pennsylvania State University College of Medicine, 1996

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

Lake Country Emergency PhysiciansGroup PAC ID 4385607555, 7 clinicians

Practice addresses (Care Compare)

Hospital & facility affiliations

• Oconomowoc Memorial Hospital Hospital, Oconomowoc, WI, CCN 520062

Procedures performed for Medicare patients

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Medicine

State licenses

Practice roles

Locations

Interoperability endpoints

• Direct secure messaging: tdietrich21733@direct.phci.org

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.

• Lake Country Emergency Physicians

  • Emergency Medicine Physician
  • Oconomowoc, WI
  • NPI 1720060585
  Medicare reassignment Care Compare group NPD
• Froedtert &the Medical College of Wisconsin Community Physicians, Inc.

  • Internal Medicine Physician
  • Menomonee Falls, WI
  • NPI 1568787448
  Medicare reassignment NPD
• Emergency Medical Associates LLP

  • Emergency Medicine Physician
  • Waukesha, WI
  • NPI 1861483190
  Medicare reassignment
• DRS. Massaro & Kalenak S C

  • Ophthalmology Physician
  • Milwaukee, WI
  • NPI 1558482364
  NPD
• Froedtert &the Medical College of Wisconsin Community Physicians, Inc.

  • Durable Medical Equipment & Medical Supplies
  • Wauwatosa, WI
  • NPI 1154947224
  NPD
• The Medical College of Wisconsin, Inc.

  • Internal Medicine Physician
  • Milwaukee, WI
  • NPI 1699720086

  Emergency Medicine

  NPD
• Ihc Beaver Dam Emergency Physicians, LLC

  • Emergency Medicine Physician
  • Beaver Dam, WI
  • NPI 1912109836
  NPD (past)
• St Josephs Hospital of the Hospital Sisters of the Third Order of St F

  • General Acute Care Hospital
  • Chippewa Falls, WI
  • NPI 1164429908
  NPD (past)
• United Occupational Medicine and Walk in Services, LLC

  • Occupational Medicine Physician
  • Pleasant Prairie, WI
  • NPI 1518915073

  Emergency Medicine

  NPD (past)
• Ihc-Libertyville Emergency Physicians, LLC

  • Emergency Medicine Physician
  • Libertyville, IL
  • NPI 1053423541
  NPD (past)
• Ihc-St. Francis Emergency Physicians, LLC

  • Emergency Medicine Physician
  • Evanston, IL
  • NPI 1780632463
  NPD (past)

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

• Prohealth Oconomowoc Memorial Hospital, Inc.

  • General Acute Care Hospital
  • Oconomowoc, WI
  • NPI 1366420531
  Care Compare affiliation
• Prohealth Oconomowoc Memorial Hospital, Inc.

  • Community/Retail Pharmacy
  • Oconomowoc, WI
  • NPI 1497942205

  Hospital

  Care Compare affiliation

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

{
    "created_epoch": "1147737600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1233014400000",
    "number": "1912959446",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "111 E WISCONSIN AVE",
            "address_2": "SUITE 2000",
            "city": "MILWAUKEE",
            "state": "WI",
            "postal_code": "532024815",
            "telephone_number": "414-290-6720",
            "fax_number": "414-290-6755"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "111 E WISCONSIN AVE",
            "address_2": "SUITE 2000",
            "city": "MILWAUKEE",
            "state": "WI",
            "postal_code": "532024815",
            "telephone_number": "414-290-6720",
            "fax_number": "414-290-6755"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "DIETRICH",
        "first_name": "THOMAS",
        "middle_name": "J",
        "credential": "M.D.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-05-16",
        "last_updated": "2009-01-27",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207P00000X",
            "taxonomy_group": "",
            "desc": "Emergency Medicine",
            "state": "WI",
            "license": "44609-020",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "MEDICARE RAILROAD",
            "identifier": "P00024625",
            "state": "WI"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "MEDICARE RAILROAD",
            "identifier": "P0030673",
            "state": "WI"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "34306000",
            "state": "WI"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "MEDICARE RAILROAD",
            "identifier": "930126400",
            "state": "WI"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Amy L Diestelhorst, M.D.
• Ashley Marie Dietrich, MD
• Lisa Dietrich
• Margaret Elizabeth Jonas Dietrich, MPT
• Peter N Dietrich, M.D.
• Catherine A Dietrick, PT
• McKenna Dietze
• Elizabeth S Dietzler, RDH
• Different Horizons Behavioral Health Services LLC
• Different Shades of Healing, LLC

• Emergency Medicine Physician in Milwaukee, WI
• Providers in Milwaukee, WI by specialty
• Emergency Medicine Physician in Wisconsin

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 27, 2009; 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.