ISAAC DIETERMAN (BA, DP-C) – Addiction (Substance Use Disorder) Counselor, NPI 1174185474

ISAAC DIETERMAN (BA, DP-C) is a healthcare provider. based in Midland, Michigan. specializing in MENTAL HEALTH COUNSELOR. They hold the professional credentials BA, DP-C. The NPI Number for ISAAC DIETERMAN (BA, DP-C) is 1174185474

Main info

Male
5 Years Of Experience
Accepts Medicare Assignment
Name
ISAAC DIETERMAN (BA, DP-C)
NPI
1174185474
Phone
(989) 774-1224
Address
5816 EASTMAN AVE
Enumeration Date
8 July 2019
Last Update Date
8 July 2019

Doctor Profile

Medical School Name
OTHER
Secondary Phone
9898020742
Graduation Year
2021 (5 years ago)
PAC ID
6800330598
Group Practice PAC ID
5395187975
Professional Enrollment ID
I20240705001891
Address ID
MI486171209CL805XXSTXX300
Data current as of
19 May 2026

Profile Insights

NPPES metrics only — not quality of care.

Methodology
Experience17
Completeness75
Years active:6State licenses:0Digital endpointsOther names

2,023 MENTAL HEALTH COUNSELOR in MI

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Provider Addresses for ISAAC DIETERMAN (BA, DP-C)

  • Indulge Salon and Day Spa, 5816, Eastman Avenue, Midland, Midland County, Michigan, 48640, United States

    MIDLAND, MI 486406792

    Phone: (989) 774-1224

    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: 2024-07-05

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
I20240705001891IMental Health CounselorMITBD

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 48640)

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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: 5395187975View full group profile
NameSpecialtyState
Mental Health CounselorMI
Clinical Social WorkerMI

Reviews

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Frequently asked questions

Is ISAAC DIETERMAN (BA, DP-C) listed with a National Provider Identifier?
Yes — ISAAC DIETERMAN (BA, DP-C) has NPI 1174185474 on file in the registry.
Is ISAAC DIETERMAN (BA, DP-C) shown as active in public data?
Registry records indicate ISAAC DIETERMAN (BA, DP-C) maintains an active NPI.
How would a patient describe ISAAC DIETERMAN (BA, DP-C)'s focus?
For ISAAC DIETERMAN (BA, DP-C), the primary taxonomy reads as Addiction (Substance Use Disorder) Counselor. Clinical services aligned with this taxonomy classification.
Is ISAAC DIETERMAN (BA, DP-C) associated with Midland?
Public fields place ISAAC DIETERMAN (BA, DP-C) around Midland, Michigan. Always confirm the exact site before visiting.
Does inactive status remove historical data?
Historical rows can remain visible after status changes — read the dates carefully.

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