Recently Updated NPI Information — some details in this NPI profile have been updated in the NPI registry within the last 60 days.

JACI RAE DIETZ
NPI 1063258788
Physician Assistant in Kearney, NE

Q: What is Jaci Dietz's NPI number?

The NPI number for Jaci Dietz is 1063258788. It was assigned to this individual provider in the NPPES registry on July 2, 2024.

Q: What is Jaci Dietz's specialty?

The primary specialty registered for this NPI is Physician Assistant with taxonomy code 363A00000X.

Q: When was this NPI record last updated?

The NPPES record for Jaci Dietz was last updated on August 20, 2026. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 6 days ago. If this record has changed at CMS more recently, you can request an on-demand re-check against the live CMS registry, directly from this page.

Active since July 02, 2024PECOS Enrolled

816 22ND AVE STE 100, KEARNEY, NE 68845(308) 865-2263(308) 865-2541 Get Directions Write a Review

NPPES record last updated: August 20, 2026. Verified against the NPPES registry weekly; last sync: August 23, 2026.

Record update history: Aug 20, 2026, Jul 2, 2024 (2 updates tracked since 2024).

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About Jaci Rae Dietz NPPES

Official registry information on file with the National Plan and Provider Enumeration System.

JACI RAE DIETZ (NPI 1063258788) is an individual physician assistant in Kearney, Nebraska, licensed in Nebraska (3364) and active in the NPI registry since July 2024. She is enrolled in Medicare PECOS, is affiliated with Kearney Regional Medical Center, and is a graduate of Other (2025).

NPPES Registry Identity

NPI1063258788

Entity TypeIndividualFemale

Primary Taxonomy363A00000X

Provider Legal NameJACI RAE DIETZ

Location Address816 22ND AVE STE 100Kearney, NE 68845-2226

Mailing Address816 22nd Ave Ste 100Kearney, NE 68845-2226 · (308) 865-2263 · Fax (308) 865-2541

Phone(308) 865-2263

Fax(308) 865-2541

Sole ProprietorNo

Medical School CMSOtherGraduated 2025

Enumeration DateJuly 2, 2024

Last NPPES UpdateAugust 20, 20262 updates tracked since enumeration

NPPES CertifiedAugust 20, 2026

✔ NPI 1063258788 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses

★ Primary SpecialtyPhysician AssistantPhysician Assistants & Advanced Practice Nursing Providers

Taxonomy Code363A00000X

License✔ Licensed in NE · 3364

Definition

A physician assistant is a person who has successfully completed an accredited education program for physician assistant, is licensed by the state and is practicing within the scope of that license. Physician assistants are formally trained to perform many of the routine, time-consuming tasks a physician can do. In some states, they may prescribe medications. They take medical histories, perform physical exams, order lab tests and x-rays, and give inoculations. Most states require that they work under the supervision of a physician.

816 22ND AVE STE 100, Kearney, NE 68845

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Medicare Participation & PECOS CMS

Medicare enrollment, assignment, and ordering and referring status from the CMS PECOS system.

Medicare Enrollment Status

✔

Enrolled in Medicare and accepts Medicare assignment

Jaci Rae Dietz is registered in PECOS and agrees to accept the Medicare-approved amount as full payment. Medicare patients are not billed beyond the standard deductible and coinsurance.

PECOS PAC ID7517441389

PECOS Enrollment IDI20260319001377

Eligible to Order & Refer✔ Part B Labs & Imaging✔ Durable Medical Equipment✔ Home Health Agency✔ Power Mobility DevicesPer the CMS Ordering and Referring file. Eligibility means Medicare pays claims that this provider orders or refers for these categories.

Hospital Affiliations CMS Care Compare

Hospitals where this provider delivers care, identified from recent Medicare claims and place-of-service records.

Kearney Regional Medical Center

Acute Care Hospitals · Kearney, NE

4/5 CMS rating

OwnershipProprietary

CMS Certification Number280134

Location804 22nd AvenueKearney, NE 68845 · Buffalo County

Emergency services Birthing friendly

Physician Visit Costs CMS claims · ZIP area

Typical Medicare office-visit costs in the 68845 ZIP code area, from fee-for-service claims. These are area statistics, not this provider’s prices; actual charges vary by service and coverage.

New Patient

$81.20 typical visit price

range $52.69 – $160.21

Typical copayment $20.30 (range $13.17 – $40.05)

Most-billed visit code 99203

Established Patient

$66.00 typical visit price

range $16.90 – $131.25

Typical copayment $16.50 (range $4.22 – $32.81)

Most-billed visit code 99213

Amounts reflect what Medicare beneficiaries in this ZIP area are typically charged for office visits. Patients with other coverage should check their individual plans.

Other Providers at the Same Location NPPES 20

Providers registered at the same practice address, or within the immediate area, according to the NPPES registry.

KELSEY PETERSON FNP-C

Nurse Practitioner (Family)