Susan Patricia Dierkes, PA-C
Individual provider Active NPI Physician Assistant · Dresden, TN
NPI 1972708402 · NPPES record last updated Oct 9, 2008
Key facts
- NPI
- 1972708402
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Physician Assistant 363A00000X
- License
- 1493 (TN)
- Practice address
- 811 Morrow St
Suite 208
Dresden, TN 38225-1846 - Phone
- (731) 364-3353
- Fax
- (731) 364-3373
- NPI assigned
- Jun 15, 2007
- Sex
- Female
- Sole proprietor
- No
Organizations & group practices 5
Hospital & facility affiliations 1
Medicare Care Compare profile
- Specialty
- Physician Assistant
- Education
- University of Nebraska College of Medicine, 2008
- Medicare assignment
- Accepts the Medicare-approved amount as payment in full
- Group practices
- Lakeside Health Clinic, P.C.
Practice addresses (Care Compare)
813 E Wood St
Paris, TN 38242-4223
Phone (731) 924-2000
Hospital & facility affiliations
- West Tennessee Healthcare Henry County Hospital
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in TN
- Eligible to order & refer
- Part B services: Yes · DME: Yes · Home health: Yes · Power mobility devices: Yes · Hospice: No
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20070914000334 | TN | Practitioner - Physician Assistant | 2769576289 | Reassigns benefits to 2 organizations |
National Provider Directory
- Medicare enrollment (NPD)
- Yes
- Credentials
- Physician Assistant
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 1493 | TN | MD | Physical Therapist |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| University Health System Inc | Physician Assistant | Current |
Accepting new patients |
| Behavioral Medicine, PLLC | Past | Accepting new patients | |
| Martin Clinic Corp | Past | Accepting new patients |
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Physician Assistant | 363A00000X | 1493 | TN | Yes |
Addresses
Primary practice location
811 Morrow St
Suite 208
Dresden, TN 38225-1846
Mailing address
811 Morrow St
Suite 208
Dresden, TN 38225-1846
Phone (731) 364-3353
Other identifiers
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 36651031 | Medicaid | TN | |
| 4180537 | Other | TN | BCBS |
| 43637 | Other | TN | TLC |
Other providers in Dresden, TN
- Alexis Cravens
- Betheny Nicole Dane
- Andrew Daniel
- Karen Marie Delmont
- Department of Health State of TN
- Dresden Chiropractic and Physical Therapy, PLLC
- Dresden Family Clinic LLC
- Dresden Medical Associates, P. C.
- Kathrine Dunlap
- Cory Ferguson
All providers in Dresden, TN · Physician Assistant in Tennessee
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Oct 9, 2008. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- Order and Referring (CMS).
- Medicare Care Compare provider data (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.