| Jay Martin Dietrich, APN, NP-C | |
|
2200 E Washington St, Bloomington, IL 61701-4364 | |
| (309) 662-3311 | |
| Not Available |
| Full Name | Jay Martin Dietrich |
|---|---|
| Gender | Male |
| Speciality | Nurse Practitioner |
| Experience | 4 Years |
| Location | 2200 E Washington St, Bloomington, Illinois |
| Accepts Medicare Assignments | Yes. He accepts the Medicare-approved amount; you will not be billed for any more than the Medicare deductible and coinsurance. |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1225629447 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 363L00000X | Nurse Practitioner | 209021931 (Illinois) | Primary |
| 163W00000X | Registered Nurse | 041446858 (Illinois) | Secondary |
| Facility Name | Location | Facility Type |
|---|---|---|
| St Joseph Medical Center | Bloomington, IL | Hospital |
| Group Practice Name | Group PECOS PAC ID | No. of Members |
|---|---|---|
| Osf Multi-specialty Group | 3678889789 | 1552 |
| Entity Name | Osf Multi-specialty Group |
|---|---|
| Entity Type | Part B Supplier - Clinic/group Practice |
| Entity Identifiers | NPI Number: 1922445527 PECOS PAC ID: 3678889789 Enrollment ID: O20150904000279 |
| Mailing Address | Practice Location Address |
|---|---|
| Jay Martin Dietrich, APN, NP-C 206 Beacon Cir, Bloomington, IL 61704-1414 Ph: (309) 502-0379 | Jay Martin Dietrich, APN, NP-C 2200 E Washington St, Bloomington, IL 61701-4364 Ph: (309) 662-3311 |
Theresa Kauth, Nurse Practitioner Medicare: Medicare Enrolled Practice Location: 108 W Market St, Bloomington, IL 61701 Phone: 309-827-5351 Fax: 309-829-6808 | |
Cheryl Hansen, APRN Nurse Practitioner Medicare: Medicare Enrolled Practice Location: 3024 E Empire St, Bloomington, IL 61704 Phone: 309-454-4411 | |
Carey Harris, Nurse Practitioner Medicare: Accepting Medicare Assignments Practice Location: 1701 E College Ave, Bloomington, IL 61704 Phone: 309-664-3000 Fax: 309-664-3026 | |
Elizabeth Jeanne Robert, APN Nurse Practitioner Medicare: Accepting Medicare Assignments Practice Location: 3024 E Empire St Ste A, Bloomington, IL 61704 Phone: 309-556-7800 Fax: 309-556-7804 | |
Ms. Linda Kay Wall, A.P.N. Nurse Practitioner Medicare: Not Enrolled in Medicare Practice Location: 318 W Washington St, 3rd Floor, Bloomington, IL 61701 Phone: 309-827-4014 Fax: 309-828-6626 | |
Amy O'brien, FNP Nurse Practitioner Medicare: Medicare Enrolled Practice Location: 1401 Eastland Dr, Bloomington, IL 61701 Phone: 309-661-3360 Fax: 309-661-3390 | |
Mrs. Sonal Mukesh Patel, NP-C Nurse Practitioner Medicare: Accepting Medicare Assignments Practice Location: 1701 E College Ave, Bloomington, IL 61704 Phone: 309-664-3800 |