Physician Compare National (NPI:1871580704)

HEALTHCARE PROVIDER: RICHARD EDWARD DIETZEN M.D.

Physician Compare National contains general information about individual eligible professionals (EPs) such as demographic information and Medicare quality program participation.

Individual Professional Information
NPI	1871580704
	Unique healthcare provider (clinician) ID assigned by NPPES
PECOS UID	9638219249
	Unique individual clinician ID assigned by PECOS
Professional Enrollment ID	I20091211000526
	Unique ID for the individual professional enrollment that is the source for the data in the observation
Provider Last Name	DIETZEN
	Individual professional last name
Provider First Name	RICHARD
	Individual professional first name
Provider Gender	M
	The provider's gender if the provider is a person.

Medical School Information
Medical School Name	UNIVERSITY OF TENNESSEE, HSC, COLLEGE OF MEDICINE
	Individual professional's medical school
Graduation Year	1980
	Individual professional's medical school graduation year
Primary Specialty	PULMONARY DISEASE
	Primary medical specialty reported by the individual professional in the selected enrollment
Secondary Specialty 1	CRITICAL CARE (INTENSIVISTS)
	First secondary medical specialty reported by the individual professional in the selected enrollment
Secondary Specialty 2	INTERNAL MEDICINE
	Second secondary medical specialty reported by the individual professional in the selected enrollment
All Secondary Specialties	CRITICAL CARE (INTENSIVISTS), INTERNAL MEDICINE
	All four secondary specialties reported by the individual professional in the selected enrollment, separated by commas

Practice Information
Line 1 Street Address	403 W OAK ST
	Group Practice or individual's line 1 address
Line 2 Street Address	SUITE 302
	Group Practice or individual's line 2 address
City	EL DORADO
	Group Practice or individual's city
State	AR
	Group Practice or individual's state
Zip Code	717304575
	Group Practice or individual's zip code (9 digits when available)

Hospital(s) Affiliation Information
Hospital Affiliation CCN 1	040088
	Medicare CCN of hospital where individual professional provides service 1
Hospital Affiliation LBN 1	MEDICAL CENTER OF SOUTH ARKANSAS
	Legal business name of hospital where individual professional provides service 1
Hospital Affiliation CCN 2	041323
	Medicare CCN of hospital where individual professional provides service 2
Hospital Affiliation LBN 2	ASHLEY COUNTY MEDICAL CENTER
	Legal business name of hospital where individual professional provides service 2
Professional Accepts Medicare Assignment	Y