MICHAEL LEE DITMARS (MD) – Surgery Physician, NPI 1265440101

MICHAEL LEE DITMARS (MD) is a healthcare provider. based in Antioch, California. specializing in GENERAL SURGERY. They hold the professional credentials MD. They hold a License No. G080207 (CA). The NPI Number for MICHAEL LEE DITMARS (MD) is 1265440101

Main info

Male
33 Years Of Experience
Accepts Medicare Assignment
Name
MICHAEL LEE DITMARS (MD)
NPI
1265440101
Phone
(925) 757-0800
Address
3903 LONE TREE WAY
Enumeration Date
4 August 2006
Last Update Date
1 December 2021

Doctor Profile

Medical School Name
UNIVERSITY OF CALIFORNIA, SAN FRANCISCO SCHOOL OF MEDICINE
Secondary Phone
6195285000
Graduation Year
1993 (33 years ago)
PAC ID
1951399849
Group Practice PAC ID
6002729175
Professional Enrollment ID
I20040907000508
Address ID
CA921202507SA4647XAVEX300

Contacts

SOAP Endpoint
https://careepicwest.kp.org:14430/Interconnect-prodcalgateway/wcf/epic.community.hie/xcpdrespondinggatewaysync.svc/scalceq
Data current as of
19 May 2026

Profile Insights

NPPES metrics only — not quality of care.

Methodology
Experience52
Completeness85
Years active:19State licenses:1Other namesUpdated within 12 months

3,317 GENERAL SURGERY in CA

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Provider Addresses for MICHAEL LEE DITMARS (MD)

  • Lone Tree Way, Antioch, Contra Costa County, California, 94509, United States

    SUITE 210

    ANTIOCH, CA 945096249

    Phone: (925) 757-0800

    Fax: (925) 757-2160

    Mailing address matches the actual address.

NPPES updates history

No NPPES updates recorded for this provider.

Prescription Activity

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Open Payments (CMS)

No Open Payments data available for this provider.

This can happen when there are no reportable CMS Open Payments records.

Medicare Enrollment & Revalidation

Source: CMS public data · Not endorsed by CMS ·

Educational use only—not medical, billing, or legal advice.

PECOS enrollment status

Participating (accepts Medicare assignment)

Enrollment effective: 2004-09-07

PECOS data refreshed: 2026-05-27

Medicare revalidation (CMS due date list)

Due date not assigned yet

CMS is tracking this Medicare enrollment for revalidation, but has not published a due date.

Enrollment records

1

Earliest due date

Not assigned (TBD)

CMS data updated

2026-06-01

Revalidation progress

  1. Medicare enrolled
  2. On CMS revalidation list
  3. Due date assigned
  4. Revalidate in PECOS

CMS enrollment records

Enrollment IDTypeSpecialtyStateDue date
I20040907000508IGeneral SurgeryCATBD

What to do next

  • No action required while the due date shows TBD.
  • Check the CMS Revalidation Lookup Tool periodically — CMS updates the list about every 60 days.
  • Do not submit a revalidation application in PECOS until CMS publishes a concrete due date.

Verify on CMS Revalidation Lookup Tool

Prepare CMS-855 application → · Look up this NPI in PECOS → · Verify on CMS PECOS

Medicare Utilization (FFS)

Source: CMS public data · Not endorsed by CMS · Beneficiary counts under 11 are suppressed in source data ·

Educational use only—not medical, billing, or legal advice.

No Medicare fee-for-service utilization data available for this provider in our database.

Insurance plans in this area (ZIP 94509)

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Group practice members

Group practice members are other physicians who share the same Group Practice PAC ID with this doctor. When doctors form a group practice and register in PECOS as a single entity, they receive a shared identification number. This table lists all providers in the same group practice.
PAC ID: 6002729175View full group profile
NameSpecialtyState
U R O L O G YOH
Nurse PractitionerCA
Internal MedicineCA
Internal MedicineCA
Internal Medicine, GastroenterologyCA
Physician AssistantCA
Emergency MedicineNC
O P H T H A L M O L O G YCA
Anesthesiology, Pain ManagementNH
Family Practice, Sports MedicineCA

Reviews

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Frequently asked questions

What NPI should I save for MICHAEL LEE DITMARS (MD)?
Save NPI 1265440101 if you need a stable reference for MICHAEL LEE DITMARS (MD).
Is MICHAEL LEE DITMARS (MD)'s enrollment marked active?
An active flag here means the NPI record is not in a deactivated state.
Can you summarize MICHAEL LEE DITMARS (MD)'s specialty in plain language?
Clinically, the directory lists MICHAEL LEE DITMARS (MD) with Surgery Physician. Clinical services aligned with this taxonomy classification.
What location metadata exists for MICHAEL LEE DITMARS (MD)?
The page summarizes Antioch, California for MICHAEL LEE DITMARS (MD); expand the address list for detail.
Is MICHAEL LEE DITMARS (MD) a real provider?
This page reflects official NPPES data for NPI 1265440101. Always confirm identity and privileges with the practice and licensing boards.

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