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ALISA MICHELLE DIETERICH R.N. M.S.N. F.N.P.
NPI 1760647465
Nurse Practitioner in Martell, CA

Active since July 22, 2008PECOS EnrolledAccepts Medicare Assignment
11333 PROSPECT DRIVE, MARTELL, CA 95654(209) 268-0560(209) 214-6946 Get Directions Write a Review

NPPES record last updated: February 11, 2022. Verified against the NPPES registry weekly; last sync: October 25, 2026.

Record update history: Feb 11, 2022, Jun 15, 2018 (2 updates tracked since 2018).

About Alisa Michelle Dieterich R.n. M.s.n. F.n.p. NPPES

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

ALISA MICHELLE DIETERICH R.N. M.S.N. F.N.P. (NPI 1760647465) is an individual nurse practitioner in Martell, California, licensed in California (NP18158) and active in the NPI registry since July 2008. She is enrolled in Medicare PECOS and is a graduate of Other (2008).

NPPES Registry Identity

NPI1760647465
Entity TypeIndividualFemale
Primary Taxonomy363L00000X
Provider Legal NameALISA MICHELLE DIETERICHCredential: R.N. M.S.N. F.N.P.
Location Address11333 PROSPECT DRIVEMartell, CA 95654
Mailing Address967 Big Sur CtEl Dorado Hills, CA 95762-4508 · (707) 486-2672
Phone(209) 268-0560
Fax(209) 214-6946
Sole ProprietorYes
Medical School CMSOtherGraduated 2008
Enumeration DateJuly 22, 2008
Last NPPES UpdateFebruary 11, 20222 updates tracked since enumeration
✔ NPI 1760647465 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses

★ Primary SpecialtyNurse PractitionerPhysician Assistants & Advanced Practice Nursing Providers
Taxonomy Code363L00000X
License✔ Licensed in CA · NP18158
Definition
(1) A registered nurse provider with a graduate degree in nursing prepared for advanced practice involving independent and interdependent decision making and direct accountability for clinical judgment across the health care continuum or in a certified specialty. (2) A registered nurse who has completed additional training beyond basic nursing education and who provides primary health care services in accordance with state nurse practice laws or statutes. Tasks performed by nurse practitioners vary with practice requirements mandated by geographic, political, economic, and social factors. Nurse practitioner specialists include, but are not limited to, family nurse practitioners, gerontological nurse practitioners, pediatric nurse practitioners, obstetric-gynecologic nurse practitioners, and school nurse practitioners.
11333 PROSPECT DRIVE, Martell, CA 95654
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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

Alisa Michelle Dieterich R.n. M.s.n. F.n.p. 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 ID6608939657
PECOS Enrollment IDI20090116000406
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

2

Medicare enrollment records show Alisa Dieterich reassigns Medicare billing to 2 organizations. Each organization bills Medicare for the services this provider delivers there; the nearest is listed first.

Permanente Medical Group Inc
36 mi
Internal Medicine
7373 WEST LANE
Stockton, CA 95210
  • Reassigned Medicare billing, California enrollment
  • 20,078 clinicians in this Medicare group
NPI 1548343510 (209) 476-2000
Regents Of The Univ Of Ca
37 mi
Clinical Child & Adolescent
2825 50TH ST
Sacramento, CA 95817
  • Reassigned Medicare billing, California enrollment
  • 2,570 clinicians in this Medicare group
NPI 1447423959 (916) 703-0315

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

Physician Visit Costs CMS claims · ZIP area

Typical Medicare office-visit costs in the 95654 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
$90.32 typical visit price
range $58.87 – $176.60
Typical copayment $22.58 (range $14.71 – $44.15)
Most-billed visit code 99203
Established Patient
$103.36 typical visit price
range $19.28 – $144.60
Typical copayment $25.84 (range $4.82 – $36.15)
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.

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 Alisa Dieterich's NPI number?

The NPI number for Alisa Dieterich is 1760647465. It was assigned to this individual provider in the NPPES registry on July 22, 2008.

Where is Alisa Dieterich located?

Alisa Dieterich practices at 11333 Prospect Drive, Martell, CA 95654. The listed phone number is (209) 268-0560.

What is Alisa Dieterich's specialty?

The primary specialty registered for this NPI is Nurse Practitioner with taxonomy code 363L00000X.

Is Alisa Dieterich enrolled in Medicare?

Yes. Alisa Dieterich 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 Alisa Dieterich's services?

According to the CMS Revalidation Reassignment List (October 2026 release), Alisa Dieterich reassigns Medicare benefits to 2 organizations: Permanente Medical Group Inc (Stockton, CA) and Regents Of The Univ Of Ca (Sacramento, CA). 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 Alisa Dieterich's services. Reassignment records can lag staffing changes; confirm current arrangements with the organization.

When was this NPI record last updated?

The NPPES record for Alisa Dieterich was last updated on February 11, 2022. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 4 years 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.