CHARLES JOSEPH DIETZEN (NPI# 1790756385) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1790756385 |
| Entity Type | Individual |
| Full Name | CHARLES JOSEPH DIETZEN |
| Credential | M.D. |
| Practice Address |
705 Riley Hospital Dr Ri 3146 Indianapolis IN 46202-5109 |
| Mailing Address |
Po Box 1026 Indianapolis IN 46206-1026 |
| Practice Telephone | 3179442353 |
| Practice Fax Number | 3179442390 |
| Mailing Telephone | 3172741201 |
| Mailing Fax Number | 3172789905 |
| Enumeration Date | 2006-01-31 |
| Last Update Date | 2013-12-18 |
| Gender Code | M |
| Is Sole Proprietor | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 2081P0010X |
Physical Medicine & Rehabilitation Specialization: Pediatric Rehabilitation Medicine |
01036773A | IN | Allopathic & Osteopathic Physicians |
| State | Issuer | Identifier | Type Code |
|---|---|---|---|
| IN | 100284930 | 05 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1417964248 | Charles David Dietzen | General Practice | 4355 Highway 58, Suite 101, Chattanooga, TN 37416-2939 | 2006-08-02 |
| Street Address |
705 RILEY HOSPITAL DR RI 3146 |
| City | INDIANAPOLIS |
| State | IN |
| Zip Code | 46202-5109 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1821095308 | Laquia Vinson | Dentist | 705 Riley Hospital Dr, Suite 4205, Indianapolis, IN 46202-5109 | 2005-06-30 |
| 1801403928 | Morgan Lewis | Nurse Anesthetist, Certified Registered | 705 Riley Hospital Dr, Indianapolis, IN 46202-5109 | 2020-09-24 |
| 1063028009 | Maham Fatima | Student in an Organized Health Care Education/Training Program | 705 Riley Hospital Dr, Indianapolis, IN 46202-5109 | 2020-09-16 |
| 1871105205 | Rosemary Bland | Nurse Practitioner | 705 Riley Hospital Dr, Ri 1134, Indianapolis, IN 46202-5109 | 2020-08-18 |
| 1720699226 | Nancy Marie Dalton | Physician Assistant | 705 Riley Hospital Dr, Indianapolis, IN 46202-5109 | 2020-08-10 |
| 1205446325 | Nadine Al Homsi | Student in an Organized Health Care Education/Training Program | 705 Riley Hospital Dr, Indianapolis, IN 46202-5109 | 2020-08-04 |
| 1477162808 | Julia Lamotte | Psychologist | 705 Riley Hospital Dr, Indianapolis, IN 46202-5109 | 2020-07-31 |
| 1154930626 | Anna Himes | Nurse Practitioner | 705 Riley Hospital Dr, Indianapolis, IN 46202-5109 | 2020-07-30 |
| 1750990230 | Victoria H Klee | Genetic Counselor, MS | 705 Riley Hospital Dr, Indianapolis, IN 46202-5109 | 2020-07-30 |
| 1134738677 | Jenna Pogorzelski | Dietitian, Registered | 705 Riley Hospital Dr, Indianapolis, IN 46202-5109 | 2020-07-30 |
| Find all providers in the same location | ||||
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1790386886 | Sara Brooke Horn | Registered Nurse | 1801 N Senate Ave Ste 3300, Indianapolis, IN 46202 | 2020-11-04 |
| 1013521905 | Zachary Camden Grimes | Registered Nurse | 720 Eskenazi Avenute, Indianapolis, IN 46202 | 2020-09-08 |
| 1790314045 | Scott C Mitchell II | Student in an Organized Health Care Education/Training Program | Indiana University School of Medicine Dept of Neurosurg, 355 W. 16th St, Gh 5100, Indianapolis, IN 46202 | 2020-04-07 |
| 1053940676 | James Patrick Kelly Iv | Student in an Organized Health Care Education/Training Program | 705 Riley Hospital Dr., Ri-5837, Indianapolis, IN 46202 | 2020-04-06 |
| 1124657697 | Betsy Wilson Stevens | Student in an Organized Health Care Education/Training Program | 705 Riley Hospital Drive, Ri-5837, Indianapolis, IN 46202 | 2020-04-06 |
| 1093340580 | Brian T Edmonds | Social Worker | Sandra Eskenazi Mental Health Center, 1700 N Illinois St, Indianapolis, IN 46202 | 2020-03-05 |
| 1326683210 | Lindsay Nicole Rich | Nurse Practitioner | 1800 N Senate Ave, Indianapolis, IN 46202 | 2019-11-14 |
| 1427693670 | Ronald Mcdonald House Charities of Central Indiana | Voluntary or Charitable | 435 Limestone Street, Indianaplois, IN 46202 | 2019-11-12 |
| 1790344760 | Kirsten Denise Leaberry | Student in an Organized Health Care Education/Training Program | Iu Health Neuroscience Center, Goodman Hall, 355 West 16th Street, Indianapolis, IN 46202 | 2019-06-12 |
| 1679138093 | Chris Olson Jr. | Student in an Organized Health Care Education/Training Program | 1701 N. Senate Blvd, Ag012, Indianapolis, IN 46202 | 2019-05-02 |
| Find all providers in zip 46202 | ||||
| Taxonomy Code | 2081P0010X |
| Grouping | Allopathic & Osteopathic Physicians |
| Classification | Physical Medicine & Rehabilitation |
| Specialization | Pediatric Rehabilitation Medicine |
| A physiatrist who utilizes an interdisciplinary approach and addresses the prevention, diagnosis, treatment and management of congenital and childhood-onset physical impairments including related or secondary medical, physical, functional, psychosocial and vocational limitations or conditions, with an understanding of the life course of disability. This physician is trained in the identification of functional capabilities and selection of the best of rehabilitation intervention strategies, with an understanding of the continuum of care. |
| Notes: Source: American Board of Medical Specialties, 2007. www.abms.org [7/1/2007: definition changed, source added] Additional Resources: American Board of Physical Medicine and Rehabilitation, 2007. http://www.abpmr.org/. Board certification for Medical Doctors (MDs) is provided by the American Board of Physical Medicine and Rehabilitation. A subspecialty certificate for PRM was approved by the ABMS in 1999. ACGME Accredited Residency Program Requirements: Early discussions underway |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1629286794 | Pediatric Rehabilitation of Indiana, Inc | Physical Medicine & Rehabilitation | 3825 N Meridian St, Indianapolis, IN 46208-4018 | 2007-05-20 |
| 1336452960 | Francisco Jose Angulo Parker | Physical Medicine & Rehabilitation | 705 Riley Hospital Dr, Ri 3146, Indianapolis, IN 46202-5109 | 2010-07-25 |
| 1679890925 | Jessica Lynn Camilleri | Physical Medicine & Rehabilitation | 705 Riley Hospital Dr, Ri 3146, Indianapolis, IN 46202-5109 | 2010-04-27 |
| 1619074036 | Denise L Carpenter | Physical Medicine & Rehabilitation | 8402 Harcourt Rd, Suite 100, Indianapolis, IN 46260-2074 | 2006-09-20 |
| 1356445878 | Jennifer V Crocker | Physical Medicine & Rehabilitation | 702 Barnhill Dr, Indianapolis, IN 46202-5128 | 2006-09-13 |
| City | INDIANAPOLIS |
| Zip Code | 46202 |
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| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.