Alisa Michelle Dieterich, RN MSN FNP is a medicare enrolled "Nurse Practitioner" in Martell, California. She graduated from nursing school in 2008 and has 16 years of diverse experience with area of expertise as Nurse Practitioner. She is a member of the group practice Regents Of The Univ Of Ca and her current practice location is
11333 Prospect Drive, Martell, California. You can reach out to her office (for appointments etc.) via phone at
(209) 268-0560.
Alisa Michelle Dieterich is licensed to practice in California (license number NP18158) and she also participates in the medicare program. She
accepts medicare assignments (which means she accepts the Medicare-approved amount; you will not be billed for any more than the Medicare deductible and coinsurance) and her NPI Number is 1760647465.
Provider's Profile
| Full Name | Alisa Michelle Dieterich |
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| Gender | Female |
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| Speciality | Nurse Practitioner |
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| Experience | 16 Years |
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| Location | 11333 Prospect Drive, Martell, California |
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| Accepts Medicare Assignments | Yes. She accepts the Medicare-approved amount; you will not be billed for any more than the Medicare deductible and coinsurance. |
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Medical Education and Training:
- Alisa Michelle Dieterich graduated from nursing school in 2008
NPI Data:
- NPI Number: 1760647465
- Provider Enumeration Date: 07/22/2008
- Last Update Date: 02/11/2022
Medicare PECOS Information:
- PECOS PAC ID: 6608939657
- Enrollment ID: I20090116000406
Medical Identifiers
Medical identifiers for Alisa Michelle Dieterich such as npi, medicare ID, medicare PIN, medicaid, etc.
| Identifier | Type | State | Issuer |
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| 1760647465 | NPI | - | NPPES |
Medical Taxonomies and Licenses
| Taxonomy | Type | License (State) | Status |
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| 363L00000X | Nurse Practitioner | NP18158 (California) | Primary |
Medical Facilities Affiliation
Group Practice Association
| Group Practice Name | Group PECOS PAC ID | No. of Members |
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| Regents Of The Univ Of Ca | 3375456619 | 1360 |
Medicare Reassignments
Some practitioners may not bill the customers directly but medicare billing happens through clinics / group practice / hospitals where the provider works. Medicare reassignment of benefits is a mechanism by which practitioners allow third parties to bill and receive payment for medicare services performed by them. Alisa Michelle Dieterich allows following entities to bill medicare on her behalf.
| Entity Name | Permanente Medical Group Inc |
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| Entity Type | Part B Supplier - Clinic/group Practice |
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| Entity Identifiers | NPI Number: 1073606299
PECOS PAC ID: 8921910225
Enrollment ID: O20031104000710 |
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| Entity Name | Regents Of The Univ Of Ca |
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| Entity Type | Part B Supplier - Clinic/group Practice |
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| Entity Identifiers | NPI Number: 1013906973
PECOS PAC ID: 3375456619
Enrollment ID: O20031111000892 |
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Medicare Part D Prescriber Enrollment
Any physician or other eligible professional who prescribes Part D drugs must either enroll in the Medicare program or opt out in order to prescribe drugs to their patients with Part D prescription drug benefit plans. Alisa Michelle Dieterich is
enrolled with medicare and thus, if eligible, can prescribe medicare part D drugs to patients with medicare part D benefits.
Mailing Address and Practice Location
| Mailing Address | Practice Location Address |
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Alisa Michelle Dieterich, RN MSN FNP
967 Big Sur Ct,
El Dorado Hills, CA 95762-4508
Ph: (707) 486-2672 | Alisa Michelle Dieterich, RN MSN FNP
11333 Prospect Drive,
Martell, CA 95654
Ph: (209) 268-0560 |
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