NPIMap

Individual provider Active NPI

Fernando Dietsch Jr., M.D.

  • Family Medicine Physician
  • Prosser, WA
National Provider Identifier
1962455535
Registry record updated Jul 9, 2007
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Medicine PhysicianTaxonomy code 207Q00000X
License
MD00041643 Issued in WA
Practice address
723 Memorial St
Prosser, WA 99350-1524
Phone
(509) 786-2222
Fax
(509) 786-6612
NPI assigned
May 17, 2006
Last updated
Jul 9, 2007By the provider in NPPES
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jul 9, 2007

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Family Medicine Physician 207Q00000X MD00041643 WA Primary

Addresses

Primary practice location

723 Memorial St
Prosser, WA 99350-1524

Mailing address

21 W Imperial St
Walla Walla, WA 99362-4457
Phone (509) 301-9342

Other identifiers 2

IdentifierTypeStateIssuer
162391OtherWALABOR & INDUSTRIES #
8325656MedicaidWA

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in WA, OR2 enrollments
Eligible to order & refer
  • Part B services
  • Medical equipment
  • Home health
  • Power mobility devices
  • Hospice
Green means eligible to order or refer.

Enrollment records 2

Enrollment IDStateProvider typePAC IDDetails
I20051219000996 WA Practitioner - Family Practice 6507888559 Reassigns benefits to 3 organizations
I20100315000766 OR Practitioner - Emergency MedicinePractitioner - Family Practice 6507888559 Reassigns benefits to 2 organizations

Care Compare profile

Medicare Care Compare
Specialty
Emergency Medicine
Education
Other, 1996
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices

Practice addresses (Care Compare)

908 10TH Ave SW
Quincy, WA 98848-1376
Phone (509) 787-3531

Hospital & facility affiliations

Merit-based Incentive Payment System (MIPS)

Final score
77.82 of 100Reported as group
Quality
64.68
Promoting interoperability
100
Improvement activities
40
Cost
47.05

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Doctor of Medicine

State licenses

LicenseStateTypeSpecialty
25209WAMDNuclear Medicine Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Sunnyside Emergency Group a Professional LLC CurrentSince Jul 3, 2014 Accepting new patients
Northwest Emergency Physicians LLC CurrentSince Dec 20, 2019 Accepting new patients
Western Healthcare Services Texas CurrentSince Mar 1, 2023 Accepting new patients
Grant County Public Hospital District 2 CurrentSince Jan 1, 2015 Accepting new patients
Lea Emergency Group LLC Past Accepting new patients
Black Hills Emergency Physicians Past Accepting new patients
Plateau Emergency Physicians Past Accepting new patients
Quantum Healthcare Medical Associates Inc. Family Medicine Past Accepting new patients

Locations

1046 6th Ave SW
Albany, OR 97321
Phone (541) 812-4000

94220 4th St
Gold Beach, OR 97444
Phone (541) 247-3000

2801 St Anthony Way
Pendleton, OR 97801
Phone (541) 276-5121

915 Anderson Dr
Aberdeen, WA 98520
Phone (360) 532-8330

520 N 4th Ave
Pasco, WA 99301
Phone (509) 544-6140

908 10th Ave SW
Quincy, WA 98848
Phone (509) 787-3503

1016 Tacoma Ave
Sunnyside, WA 98944
Phone (509) 823-6682

1717 S J St
Tacoma, WA 98405
Phone (253) 426-4101

Interoperability endpoints

  • Direct secure messaging: fdietsch1331299@direct.lhs.org
  • Direct secure messaging: fernando.dietsch.1@15048.direct.athenahealth.com

Organizations & group practices 8

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.

Hospital & facility affiliations 2

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

NPI Registry JSON

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

{
    "created_epoch": "1147824000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1183939200000",
    "number": "1962455535",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "21 W IMPERIAL ST",
            "city": "WALLA WALLA",
            "state": "WA",
            "postal_code": "993624457",
            "telephone_number": "509-301-9342",
            "fax_number": "509-786-6612"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "723 MEMORIAL ST",
            "city": "PROSSER",
            "state": "WA",
            "postal_code": "993501524",
            "telephone_number": "509-786-2222",
            "fax_number": "509-786-6612"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "DIETSCH",
        "first_name": "FERNANDO",
        "name_suffix": "Jr.",
        "credential": "M.D.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-05-17",
        "last_updated": "2007-07-09",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "WA",
            "license": "MD00041643",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "LABOR & INDUSTRIES #",
            "identifier": "162391",
            "state": "WA"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "8325656",
            "state": "WA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Prosser, WA

Sources for this page

Verify at the official NPI Registry.