JACKSON RAY DIEDE, MAT, ATC — NPI 1760054373 (Licensed & Credentialed Allopathic & Osteopathic Physicians — Physical Medicine & Rehabilitation, Sports Medicine in SIOUX FALLS, SD)

CMS-1500 Box 24J / 33a • NPI

1760054373

Type 1 Individual Rendering/Ordering

HIPAA NUCC Taxonomy • CMS Code

2081S0010X (CMS 23)

Licensed & Credentialed Allopathic & Osteopathic Physicians — Physical Medicine & Rehabilitation, Sports Medicine

Box 32 Service Location & ZIP+4

810 E 23RD ST, SIOUX FALLS, SD, 57105-2135

✓ 9-Digit EDI 837 ZIP+4 (57105-2135)

Practice Phone & Referral Fax

(605) 331-5890

Direct NPPES Verification Line

✓ HHS OIG LEIE Sanction Screening — VERIFIED CLEAR: NPI 1760054373 (JACKSON RAY DIEDE, MAT, ATC) has 0 active federal exclusions across all 84,224 HHS OIG LEIE sanction records (Database Verified: 2026-11-11).

CMS Medicare Order & Referring PECOS Eligibility

This practitioner does not currently appear in the CMS individual Order & Referring PECOS file (may practice in pediatrics, commercial-only networks, or hospital-employed settings).

Official CMS NPPES Credential & Practice Profile

10-Digit NPI Number	`1760054373` (NPI-1 Individual Practitioner)
Provider / Legal Name	JACKSON RAY DIEDE, MAT, ATC
Plain-English Specialty	Licensed & Credentialed Allopathic & Osteopathic Physicians — Physical Medicine & Rehabilitation, Sports Medicine NUCC Code: `2081S0010X` (Physical Medicine & Rehabilitation, Sports Medicine)
Certifying / Licensing Body	State Medical / Healthcare Licensing Board & National Specialty Board
Practice Location Address	810 E 23RD ST, SIOUX FALLS, SD, 57105-2135
Practice Telephone / Fax	Tel: (605) 331-5890
Administrative Mailing Address	117 S HIGH ST, MENNO, SD, 57045-2170
Enumeration & Last Sync	Enumerated: 2021-07-13 \| CMS Record Updated: 2021-07-13

Clinic Location, Accessibility & Directions

📍 Practice Location & Patient Access

810 E 23RD ST, SIOUX FALLS, SD, 57105-2135

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Plain-English Taxonomy & CMS Crosswalk (2081S0010X)

What Does Taxonomy Code 2081S0010X Mean?

In the HIPAA National Uniform Claim Committee (NUCC) classification, code 2081S0010X translates to:
"Licensed & Credentialed Allopathic & Osteopathic Physicians — Physical Medicine & Rehabilitation, Sports Medicine"

CMS-1500 Medicare Specialty Crosswalk: CMS Code 23 (Physician/Sports Medicine) • CMS Code 25 (Physician/Physical Medicine and Rehabilitation)
Certifying / Accrediting Authority: State Medical / Healthcare Licensing Board & National Specialty Board
Clinical Scope: Consult a verified Physical Medicine & Rehabilitation, Sports Medicine for specialized diagnostic evaluation, treatment planning, and continuity of care.

Specialty Clinical Procedures & Therapeutic Classes

Standard Scope of Care (JACKSON RAY DIEDE, MAT, ATC)

Typical CPT / Diagnostic Procedures:

Comprehensive Outpatient & Inpatient Clinical Evaluation (CPT 99202–99215)
Diagnostic Workup, Laboratory Ordering & Evidence-Based Care Coordination
Preventive Screening, Patient Counseling & Multidisciplinary Referral

Common Therapeutic Classes:

Evidence-Based Specialty Pharmacotherapy & Preventive Regimens (CMS Part D Standard)

All Registered NUCC Taxonomies & State Licenses

Taxonomy Code & Plain-English Description	State License & Primary Status
`2081S0010X` — Physical Medicine & Rehabilitation, Sports Medicine Plain English: Licensed & Credentialed Allopathic & Osteopathic Physicians — Physical Medicine & Rehabilitation, Sports Medicine	State: SD \| License: `0714` \| Primary: Yes (Primary)

Medical Billing, RCM & Hospital Credentialing Teams:

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JACKSON RAY DIEDE, MAT, ATC (NPI #1760054373)