DIANE JUNE DOUGLASS, CDN, DTR — NPI 1821210691 (Licensed & Credentialed Dietetic Technician, Registered in COBLESKILL, NY)

CMS-1500 Box 24J / 33a • NPI

1821210691

Type 1 Individual Rendering/Ordering

HIPAA NUCC Taxonomy • CMS Code

136A00000X

Licensed & Credentialed Dietetic Technician, Registered

Box 32 Service Location & ZIP+4

178 GRANDVIEW DR, BASSETT HOSPITAL OF SCHOHARIE COUNTY, COBLESKILL, NY, 12043-5144

✓ 9-Digit EDI 837 ZIP+4 (12043-5144)

Practice Phone & Referral Fax

(518) 254-3403

Direct NPPES Verification Line

✓ HHS OIG LEIE Sanction Screening — VERIFIED CLEAR: NPI 1821210691 (DIANE JUNE DOUGLASS, CDN, DTR) 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	`1821210691` (NPI-1 Individual Practitioner)
Provider / Legal Name	DIANE JUNE DOUGLASS, CDN, DTR
Plain-English Specialty	Licensed & Credentialed Dietetic Technician, Registered NUCC Code: `136A00000X` (Dietetic Technician, Registered)
Certifying / Licensing Body	State Medical / Healthcare Licensing Board & National Specialty Board
Practice Location Address	178 GRANDVIEW DR, BASSETT HOSPITAL OF SCHOHARIE COUNTY, COBLESKILL, NY, 12043-5144
Practice Telephone / Fax	Tel: (518) 254-3403
Administrative Mailing Address	7 SHAPER AVE, CANAJOHARIE, NY, 13317-1326
Enumeration & Last Sync	Enumerated: 2007-05-02 \| CMS Record Updated: 2025-09-11

Clinic Location, Accessibility & Directions

📍 Practice Location & Patient Access

178 GRANDVIEW DR, BASSETT HOSPITAL OF SCHOHARIE COUNTY, COBLESKILL, NY, 12043-5144

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Plain-English Taxonomy & CMS Crosswalk (136A00000X)

What Does Taxonomy Code 136A00000X Mean?

In the HIPAA National Uniform Claim Committee (NUCC) classification, code 136A00000X translates to:
"Licensed & Credentialed Dietetic Technician, Registered"

CMS-1500 Medicare Specialty Crosswalk: Standard HIPAA X12N 837P / CMS-1500
Certifying / Accrediting Authority: State Medical / Healthcare Licensing Board & National Specialty Board
Clinical Scope: Consult a verified Dietetic Technician, Registered for specialized diagnostic evaluation, treatment planning, and continuity of care.

Specialty Clinical Procedures & Therapeutic Classes

Standard Scope of Care (DIANE JUNE DOUGLASS, CDN, DTR)

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
`133N00000X` — Nutritionist Plain English: Licensed & Credentialed Nutritionist	State: NY \| License: `004410` \| Primary: Secondary
`136A00000X` — Dietetic Technician, Registered Plain English: Licensed & Credentialed Dietetic Technician, Registered	State: NY \| License: `708965` \| Primary: Yes (Primary)

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DIANE JUNE DOUGLASS, CDN, DTR (NPI #1821210691)