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LAURA E DIETRICH-LAKE FNP-C
NPI 1639684046
Nurse Practitioner - Psychiatric/Mental Health in Phoenix, AZ

Active since December 07, 2017PECOS EnrolledAccepts Medicare Assignment
4707 N 12TH ST, PHOENIX, AZ 85014(602) 344-2506(602) 247-9506 Get Directions Write a Review

NPPES record last updated: January 27, 2026. Verified against the NPPES registry weekly; last sync: November 01, 2026.

Record update history: Jan 27, 2026, Mar 17, 2018, Jan 10, 2018 and 1 more (4 updates tracked since 2017).

About Laura E Dietrich-lake Fnp-c NPPES

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

LAURA E DIETRICH-LAKE FNP-C (NPI 1639684046) is an individual psychiatric/mental health provider in Phoenix, Arizona, licensed in Arizona (AP10869) and active in the NPI registry since December 2017. She is enrolled in Medicare PECOS, maintains a secondary practice location in Gilbert, and is a graduate of Other (2017).

NPPES Registry Identity

NPI1639684046
Entity TypeIndividualFemale
Primary Taxonomy363LP0808X
Provider Legal NameLAURA E DIETRICH-LAKECredential: FNP-C
Location Address4707 N 12TH STPhoenix, AZ 85014-4009
Mailing Address2929 E Thomas RdPhoenix, AZ 85016-8034 · (602) 470-5000 · Fax (602) 470-5064
Phone(602) 344-2506
Fax(602) 247-9506
Sole ProprietorNo
Medical School CMSOtherGraduated 2017
Enumeration DateDecember 7, 2017
Last NPPES UpdateJanuary 27, 20264 updates tracked since enumeration
NPPES CertifiedJanuary 27, 2026
✔ NPI 1639684046 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses 2

★ Primary SpecialtyNurse Practitioner · Psychiatric/Mental HealthPhysician Assistants & Advanced Practice Nursing Providers
Taxonomy Code363LP0808X
License✔ Licensed in AZ · AP10869
Also ListedNurse Practitioner · FamilyTaxonomy 363LF0000X · License AP10869 (AZ)
4707 N 12TH ST, Phoenix, AZ 85014
Open in Google Maps ↗

Secondary Practice Location 1

Location 13555 S Val Vista DrGilbert, AZ 85297-7323 · Phone (480) 728-8000

Accepted Insurance

The full list of accepted plans is on the Insurance tab. Issuers include Antidote Health Plan of Arizona, Inc., Blue Cross Blue Shield of Arizona, Cigna HealthCare of Arizona, Inc and more.Insurance ›

Medicare Participation & PECOS CMS

Medicare enrollment, assignment, billing reassignment, and ordering and referring status from CMS.

Medicare Enrollment Status

✔

Enrolled in Medicare and accepts Medicare assignment

Laura E Dietrich-lake Fnp-c 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 ID8325300551
PECOS Enrollment IDI20180327002419
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.

Medicare Billing Reassignments

5

Medicare enrollment records show Laura Dietrich-lake reassigns Medicare billing to 5 organizations. Each organization bills Medicare for the services this provider delivers there; the nearest is listed first.

Jewish Family & Children's Service
2.5 mi
Community/Behavioral Health
2033 N 7TH ST
Phoenix, AZ 85006
  • Reassigned Medicare billing, Arizona enrollment
  • Medicare enrollment name: Jewish Family & Childrens Service
  • 136 clinicians in this Medicare group
NPI 1023174455 (602) 279-7655
District Medical Group, Inc
3.7 mi
Surgery
2525 E ROOSEVELT ST, MED CLINIC - INFECTIOUS DISEASE
Phoenix, AZ 85008
  • Reassigned Medicare billing, Arizona enrollment
  • 1,490 clinicians in this Medicare group
NPI 1174856280 (602) 344-1095
Maricopa County Special Health Care District
3.7 mi
Adult Mental Health
2525 E ROOSEVELT ST
Phoenix, AZ 85008
  • Reassigned Medicare billing, Arizona enrollment
  • 285 clinicians in this Medicare group
NPI 1205295581 (602) 344-8178
Partners In Recovery LLC
4.0 mi
Clinic/Center
333 N 24TH ST, 100
Phoenix, AZ 85008
  • Reassigned Medicare billing, Arizona enrollment
  • 60 clinicians in this Medicare group
NPI 1992656789 (480) 969-3800
Kmtrask, PLLC
23 mi
Nurse Practitioner
2200 E WILLIAMS FIELD RD STE 200
Gilbert, AZ 85295
  • Reassigned Medicare billing, Arizona enrollment
  • 39 clinicians in this Medicare group
NPI 1518413962 (480) 590-2123

Source: CMS Revalidation Reassignment List, October 2026 release. Reassignment records can lag staffing changes; confirm a current affiliation with the organization.

Areas of Expertise CMS Part B claims 2

Services this provider delivered to Medicare fee-for-service patients, from the CMS Medicare utilization data. Higher counts generally reflect more experience with a service; care delivered outside Medicare is not included.

Subsequent hospital care with straightforward or low level of medical decision making, per day, if using time, at least 25 minutes 99231
Follow-up hospital inpatient care is a daily service where a healthcare professional checks on your health progress during your hospital stay. Each session typically lasts 15 minutes, involving updates on your condition and adjustments to your treatment plan, if necessary.
48 services14 patients
Subsequent hospital care with moderate levelof medical decision making, if using time, at least 35 minutes 99232
Follow-up hospital inpatient care involves daily check-ups while you're admitted in the hospital. Typically, a healthcare provider spends about 25 minutes each day reviewing your condition, adjusting treatment if needed, and answering any questions you might have.
39 services32 patients

Physician Visit Costs CMS claims · ZIP area

Typical Medicare office-visit costs in the 85014 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
$85.89 typical visit price
range $55.44 – $168.60
Typical copayment $21.47 (range $13.86 – $42.15)
Most-billed visit code 99203
Established Patient
$98.00 typical visit price
range $17.72 – $137.41
Typical copayment $24.50 (range $4.43 – $34.35)
Most-billed visit code 99214
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 2

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

MAGELLAN HEALTH SERVICES OF ARIZONA, INC.
Case Management
4707 N 12TH ST
PHOENIX, AZ 85014
Maricopa County (602) 241-4600
JODI ERICKSON LCSW
Social Worker (Clinical)
4707 N 12TH ST
PHOENIX, AZ 85014
Maricopa County (602) 241-4600

Frequently Asked Questions NPPES & CMS

Common questions about this NPI record, answered from the official NPPES registry and CMS datasets shown on this page.

What is Laura Dietrich-lake's NPI number?

The NPI number for Laura Dietrich-lake is 1639684046. It was assigned to this individual provider in the NPPES registry on December 7, 2017.

Where is Laura Dietrich-lake located?

Laura Dietrich-lake practices at 4707 N 12th St, Phoenix, AZ 85014. The listed phone number is (602) 344-2506.

What is Laura Dietrich-lake's specialty?

The primary specialty registered for this NPI is Nurse Practitioner, specializing in Psychiatric/Mental Health, with taxonomy code 363LP0808X.

Is Laura Dietrich-lake enrolled in Medicare?

Yes. Laura Dietrich-lake is registered in the Medicare PECOS system and accepts Medicare assignment, which means accepting the Medicare-approved amount as payment in full for covered services.

Which organizations bill Medicare for Laura Dietrich-lake's services?

According to the CMS Revalidation Reassignment List (October 2026 release), Laura Dietrich-lake reassigns Medicare benefits to 5 organizations: Jewish Family & Children's Service (Phoenix, AZ), District Medical Group, Inc (Phoenix, AZ), Maricopa County Special Health Care District (Phoenix, AZ), Partners In Recovery LLC (Phoenix, AZ) and Kmtrask, PLLC (Gilbert, AZ). Each reassignment is filed with Medicare on form CMS-855R, signed by both the clinician and the organization, and lets the organization bill Medicare and receive payment for Laura Dietrich-lake's services. Reassignment records can lag staffing changes; confirm current arrangements with the organization.

What insurance does Laura Dietrich-lake accept?

Health plans from Antidote Health Plan of Arizona, Inc., Blue Cross Blue Shield of Arizona, Cigna HealthCare of Arizona, Inc and Imperial Insurance Companies, Inc. list Laura Dietrich-lake as in-network in at least one marketplace plan. Coverage varies by plan and year; verify with the insurer or the provider before a visit.

When was this NPI record last updated?

The NPPES record for Laura Dietrich-lake was last updated on January 27, 2026. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 9 months 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.