DR. CLIFTON DIETRICK MD
NPI 1962189308
Pediatrics in Charleston, SC

Q: What is Clifton Dietrick's NPI number?

The NPI number for Clifton Dietrick is 1962189308. It was assigned to this individual provider in the NPPES registry on June 28, 2023.

Q: What is Clifton Dietrick's specialty?

The primary specialty registered for this NPI is Pediatrics with taxonomy code 208000000X.

Q: When was this NPI record last updated?

The NPPES record for Clifton Dietrick was last updated on June 28, 2023. NPI Profile syncs with the weekly NPPES data releases published by CMS.

Active since June 28, 2023PECOS Enrolled

169 ASHLEY AVE RM 202, CHARLESTON, SC 29425(724) 831-9949 Get Directions Write a Review

NPPES record last updated: June 28, 2023. Verified against the NPPES registry weekly; last sync: July 26, 2026.

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About Dr. Clifton Dietrick Md NPPES

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

DR. CLIFTON DIETRICK MD (NPI 1962189308) is an individual pediatrics provider in Charleston, South Carolina, licensed in South Carolina (LL90355) and active in the NPI registry since June 2023. He is enrolled in Medicare PECOS.

NPPES Registry Identity

NPI1962189308

Entity TypeIndividualMale

Primary Taxonomy208000000X

Provider Legal NameDR. CLIFTON DIETRICKCredential: MD

Location Address169 ASHLEY AVE RM 202Charleston, SC 29425-8905

Mailing Address169 Ashley Ave Rm 202Charleston, SC 29425-8905

Phone(724) 831-9949

Sole ProprietorNo

Enumeration DateJune 28, 2023

NPPES CertifiedJune 28, 2023

✔ NPI 1962189308 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses

★ Primary SpecialtyPediatricsAllopathic & Osteopathic Physicians

Taxonomy Code208000000X

License✔ Licensed in SC · LL90355

Definition

A pediatrician is concerned with the physical, emotional and social health of children from birth to young adulthood. Care encompasses a broad spectrum of health services ranging from preventive healthcare to the diagnosis and treatment of acute and chronic diseases. A pediatrician deals with biological, social and environmental influences on the developing child, and with the impact of disease and dysfunction on development.

169 ASHLEY AVE RM 202, Charleston, SC 29425

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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 (PECOS)

Dr. Clifton Dietrick Md 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 29425 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

$83.18 typical visit price

range $53.57 – $163.84

Typical copayment $20.79 (range $13.39 – $40.96)

Most-billed visit code 99203

Established Patient

$95.12 typical visit price

range $16.96 – $133.52

Typical copayment $23.78 (range $4.24 – $33.38)

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.