DIANE L DEJONG PHYSICIAN ASSISTANT
NPI 1124008354
Physician Assistant in Sully, IA

Active since January 23, 2006PECOS Enrolled
81.6/100
CMS Quality Rating
704 3RD ST, SULLY, IA 50251(641) 594-3150(641) 594-3795 Get Directions Write a Review

NPPES record last updated: August 31, 2022. Verified against the NPPES registry weekly; last sync: July 19, 2026.

Record update history: Aug 31, 2022, Jan 8, 2021 (2 updates tracked since 2021).

About Diane L Dejong Physician Assistant NPPES

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

DIANE L DEJONG PHYSICIAN ASSISTANT (NPI 1124008354) is an individual physician assistant in Sully, Iowa, licensed in Iowa (001494) and active in the NPI registry since January 2006. She is enrolled in Medicare PECOS and maintains a secondary practice location in Pella.

NPPES Registry Identity

NPI1124008354
Entity TypeIndividualFemale
Primary Taxonomy363A00000X
Provider Legal NameDIANE L DEJONGCredential: PHYSICIAN ASSISTANT
Location Address704 3RD STSully, IA 50251-1016
Mailing Address704 3rd StSully, IA 50251-1016 · (641) 594-3150 · Fax (641) 594-3795
Fax(641) 594-3795
Sole ProprietorNo
Enumeration DateJanuary 23, 2006
Last NPPES UpdateAugust 31, 20222 updates tracked since enumeration
NPPES CertifiedAugust 31, 2022
NPI 1124008354 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses 2

Primary SpecialtyPhysician AssistantPhysician Assistants & Advanced Practice Nursing Providers
Taxonomy Code363A00000X
License Licensed in IA · 001494
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.

Also ListedPhysician Assistant · MedicalTaxonomy 363AM0700X · License 001494 (IA)
704 3RD ST, Sully, IA 50251

Secondary Practice Location 1

Location 1405 Monroe StPella, IA 50219-1189 · Phone (641) 621-2200 · Fax (641) 621-2335

Accepted Insurance

Medicare Participation & PECOS CMS

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

Medicare Enrollment Status

Enrolled in Medicare (PECOS)

Diane L Dejong Physician Assistant is registered in the CMS Provider Enrollment, Chain and Ownership System (PECOS).

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.

Physician Visit Costs CMS claims · ZIP area

Typical Medicare office-visit costs in the 50251 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
$81.84 typical visit price
range $52.96 – $161.40
Typical copayment $20.46 (range $13.24 – $40.35)
Most-billed visit code 99203
Established Patient
$66.36 typical visit price
range $16.91 – $131.98
Typical copayment $16.59 (range $4.22 – $32.99)
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.

Medicare Quality Performance CMS QPP · MIPS

Performance in the CMS Quality Payment Program: the MIPS final score across four weighted categories, and the individual quality measures reported to Medicare.

81.6/100
MIPS Final ScoreMerit-based Incentive Payment System · CMS Quality Payment Program
Scored as part of a group practice
Quality87.55
Promoting Interoperability100
Improvement Activities40
Cost51.12

Referred Medical Equipment & Supplies CMS DME claims 2

Durable medical equipment, devices and supplies this provider ordered from DME suppliers for patients, from Medicare fee-for-service claims.

Blood glucose test or reagent strips for home blood glucose monitor, per 50 strips A4253
DME-Other DME · category DE017N
7 suppliers24 claims35 services$5.48 avg. paid by Medicare
Supply allowance for therapeutic continuous glucose monitor (cgm), includes all supplies and accessories, 1 month supply = 1 unit of service K0553
DME-Other DME · category DE017N
1 supplier11 claims12 services$185.34 avg. paid by Medicare
Dollar amounts are the average Medicare paid the supplier per service. They are not the cost to the patient.

Other Providers at the Same Location NPPES

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

Clinic/Center (Rural Health)
704 3RD ST
SULLY, IA 50251

Frequently Asked Questions

The NPI number assigned to this healthcare provider is 1124008354, enumerated as an "individual" on January 23, 2006.

The provider is located at 704 3RD ST SULLY, IA 50251 and the phone number is (641) 594-3150.

Physician Assistant with taxonomy code 363A00000X.

The provider might be accepting Accepts: Ambetter from Home State Health, Ambetter from NH. Please consult your insurance carrier or call the provider to verify.