Active NPI 1942422498 Individual Practitioner Male Practitioner

Dr. Ryan Diederich , MD

Surgery - Plastic and Reconstructive Surgery • Glen Carbon, IL

Professional Overview & Biography Verified Profile Summary

Dr. Ryan Diederich, MD is a registered healthcare professional specializing in Surgery - Plastic and Reconstructive Surgery in Glen Carbon, IL. Practice services are available at 4955 S STATE ROUTE 159 STE 1 under active NPI credentials.

Frequently performed procedures and clinical services include established patient outpatient office visit, injection, betamethasone acetate 3 mg and betamethasone sodium phosphate 3 mg, new patient outpatient office visit. Full Medicare procedure pricing transparency rates and service volume details are listed on this profile.

Practice Location & Contact Primary Location

Practice Address

4955 S State Route 159 Ste 1

Glen Carbon, IL 620341907

Telephone 6182887855

Fax 6182887866

Associated Practice Facility / Clinic

🏢 Ryan S. Diederich, Md Pc Facility NPI 1639817182

Specialty Benchmarks & Practice Insights

Comparative analytics for Surgery - Plastic and Reconstructive Surgery in Glen Carbon, IL

Active Practitioner

Practitioner Clinical Experience

Active

City Avg: 10.5 Yrs

State Avg: 24.1 Yrs

Regional Practice Density

1 Specialists

Practicing in Glen Carbon, IL (138 Statewide)

Telehealth Adoption Rate

0.0% Regional Adoption

In-Person Office Visits Only

Medicare Pricing Discount

48.9% Avg Savings

Under CMS Medicare Fee Schedule vs Standard Submitted Charges

Performed Procedures & Service Volume

Top Medicare Part B procedures performed by this practitioner

CMS Official Data (2022)

Reporting Year:

HCPCS Code & Description	Services	Patients	Submitted Charge	Medicare Allowed
99212 Established patient office or other outpatient visit with straightforward medical decision making, if using time, 10 minutes or more	17	13	$111.00	$56.70

HCPCS Code & Description	Services	Patients	Submitted Charge	Medicare Allowed
99212 Established patient office or other outpatient visit with straightforward medical decision making, if using time, 10 minutes or more	24	16	$111.00	$55.13

HCPCS Code & Description	Services	Patients	Submitted Charge	Medicare Allowed
J0702 Injection, betamethasone acetate 3 mg and betamethasone sodium phosphate 3 mg	51	12	$18.00	$7.04
99214 Established patient office or other outpatient visit with moderate level of decision making, if using time, 30 minutes or more	35	31	$273.00	$110.77
99213 Established patient office or other outpatient visit, typically 15 minutes	33	25	$185.00	$74.94
99203 New patient office or other outpatient visit with low level of medical decision making, if using time, 30 minutes or more	26	26	$277.00	$110.38
99204 New patient office or other outpatient visit with moderate level of medical decision making, if using time, 45 minutes or more	17	17	$423.00	$160.98

HCPCS Code & Description	Services	Patients	Submitted Charge	Medicare Allowed
17003 Destruction of precancer skin growth, 2-14 growths	581	85	$14.00	$5.78
17000 Destruction of skin growth	132	101	$168.00	$54.54
99213 Established patient office or other outpatient visit, typically 15 minutes	119	86	$185.00	$74.62
11104 Punch biopsy, first skin growth	65	59	$310.00	$122.19
J0702 Injection, betamethasone acetate 3 mg and betamethasone sodium phosphate 3 mg	44	20	$18.00	$6.78
99202 New patient office or other outpatient visit, typically 20 minutes	36	36	$191.00	$76.39
99203 New patient office or other outpatient visit with low level of medical decision making, if using time, 30 minutes or more	33	33	$277.00	$108.23
17004 Destruction of precancer skin growth, 15 or more growths	32	28	$365.56	$153.81
11642 Removal of cancer skin growth of face, ears, eyelids, nose, lips, or mouth, 1.1-2.0 cm	25	24	$698.00	$228.26
11105 Punch biopsy, each additional skin growth	25	17	$154.00	$61.00
99212 Established patient office or other outpatient visit with straightforward medical decision making, if using time, 10 minutes or more	25	22	$111.00	$45.03
99214 Established patient office or other outpatient visit with moderate level of decision making, if using time, 30 minutes or more	24	23	$273.00	$109.37
12051 Intermediate repair of wound of face, ears, eyelids, nose, lips, or mouth, 2.5 cm or less	23	22	$661.00	$152.47
20550 Injection into tendon or ligament	22	21	$139.14	$52.74
17110 Destruction of up to 14 skin growths	20	20	$279.00	$102.83
12032 Intermediate repair of wound of scalp, underarms, trunk, arms, or legs, 2.6-7.5 cm	16	16	$769.00	$221.46
11643 Removal of malignant growth (2.1 to 3.0 centimeters) of the face, ears, eyelids, nose, or lips	13	12	$829.00	$316.84

HCPCS Code & Description	Services	Patients	Submitted Charge	Medicare Allowed
17003 Destruction of precancer skin growth, 2-14 growths	728	103	$20.94	$5.36
99213 Established patient office or other outpatient visit, typically 15 minutes	194	151	$126.86	$72.40
17000 Destruction of skin growth	164	126	$158.84	$54.40
11100 Biopsy of single growth of skin and/or tissue	112	100	$241.77	$99.59
99203 New patient office or other outpatient visit with low level of medical decision making, if using time, 30 minutes or more	89	89	$195.42	$108.04
J0702 Injection, betamethasone acetate 3 mg and betamethasone sodium phosphate 3 mg	83	28	$18.00	$6.92
99202 New patient office or other outpatient visit, typically 20 minutes	63	63	$123.50	$74.77
11642 Removal of cancer skin growth of face, ears, eyelids, nose, lips, or mouth, 1.1-2.0 cm	61	50	$635.49	$236.42
99212 Established patient office or other outpatient visit with straightforward medical decision making, if using time, 10 minutes or more	56	44	$88.82	$43.40
11101 Biopsy of each additional growth of skin and/or tissue	52	29	$78.00	$33.57
17110 Destruction of up to 14 skin growths	49	47	$254.59	$109.99
99214 Established patient office or other outpatient visit with moderate level of decision making, if using time, 30 minutes or more	49	48	$176.42	$106.99
12051 Intermediate repair of wound of face, ears, eyelids, nose, lips, or mouth, 2.5 cm or less	42	42	$530.50	$148.49
17004 Destruction of precancer skin growth, 15 or more growths	38	31	$425.84	$145.44
20550 Injection into tendon or ligament	35	25	$144.60	$48.49
11641 Removal of cancer skin growth of face, ears, eyelids, nose, lips, or mouth, 0.6-1.0 cm	28	27	$529.18	$194.91
12032 Intermediate repair of wound of scalp, underarms, trunk, arms, or legs, 2.6-7.5 cm	27	25	$593.89	$212.74
11643 Removal of malignant growth (2.1 to 3.0 centimeters) of the face, ears, eyelids, nose, or lips	22	21	$724.50	$311.34
11602 Removal of cancer skin growth of body, arms, or legs, 1.1-2.0 cm	20	17	$533.00	$187.53
12031 Intermediate repair of wound of scalp, underarms, trunk, arms, or legs, 2.5 cm or less	20	19	$437.70	$160.89
11603 Removal of cancer skin growth of body, arms, or legs, 2.1-3.0 cm	14	14	$673.14	$247.31
11622 Removal of cancer skin growth of scalp, neck, hands, feet, or genitals, 1.1-2.0 cm	14	12	$562.43	$194.25
11402 Removal of noncancer skin growth of body, arms, or legs, 1.1-2.0 cm	13	12	$377.62	$116.33
12052 Repair of wound (2.6 to 5.0 centimeters) of face, ears, eyelids, nose, lips, and/or mouth	12	12	$678.50	$173.61
11604 Removal of cancer skin growth of body, arms, or legs, 3.1-4.0 cm	12	11	$770.83	$267.17

HCPCS Code & Description	Services	Patients	Submitted Charge	Medicare Allowed
17003 Destruction of precancer skin growth, 2-14 growths	845	129	$30.00	$5.66
99213 Established patient office or other outpatient visit, typically 15 minutes	288	226	$95.00	$72.04
17000 Destruction of skin growth	205	158	$150.00	$56.17
11100 Biopsy of single growth of skin and/or tissue	93	88	$220.00	$98.14
J0702 Injection, betamethasone acetate 3 mg and betamethasone sodium phosphate 3 mg	79	25	$18.00	$6.98
99202 New patient office or other outpatient visit, typically 20 minutes	78	78	$95.00	$74.48
11642 Removal of cancer skin growth of face, ears, eyelids, nose, lips, or mouth, 1.1-2.0 cm	73	67	$575.00	$252.68
99203 New patient office or other outpatient visit with low level of medical decision making, if using time, 30 minutes or more	73	73	$139.42	$106.66
12051 Intermediate repair of wound of face, ears, eyelids, nose, lips, or mouth, 2.5 cm or less	51	50	$400.00	$139.26
99214 Established patient office or other outpatient visit with moderate level of decision making, if using time, 30 minutes or more	51	47	$135.00	$106.74
99212 Established patient office or other outpatient visit with straightforward medical decision making, if using time, 10 minutes or more	45	39	$65.00	$43.07
17004 Destruction of precancer skin growth, 15 or more growths	35	27	$489.00	$143.75
20550 Injection into tendon or ligament	32	21	$142.00	$49.11
17110 Destruction of up to 14 skin growths	30	30	$230.67	$108.32
12031 Intermediate repair of wound of scalp, underarms, trunk, arms, or legs, 2.5 cm or less	26	26	$300.00	$148.59
11101 Biopsy of each additional growth of skin and/or tissue	23	17	$70.00	$33.60
12032 Intermediate repair of wound of scalp, underarms, trunk, arms, or legs, 2.6-7.5 cm	21	21	$375.00	$223.16
11641 Removal of cancer skin growth of face, ears, eyelids, nose, lips, or mouth, 0.6-1.0 cm	21	20	$460.00	$205.92
11643 Removal of malignant growth (2.1 to 3.0 centimeters) of the face, ears, eyelids, nose, or lips	19	17	$620.00	$299.79
11622 Removal of cancer skin growth of scalp, neck, hands, feet, or genitals, 1.1-2.0 cm	19	17	$490.00	$214.55
12052 Repair of wound (2.6 to 5.0 centimeters) of face, ears, eyelids, nose, lips, and/or mouth	19	19	$600.00	$166.65
11603 Removal of cancer skin growth of body, arms, or legs, 2.1-3.0 cm	15	15	$450.00	$210.17
11402 Removal of noncancer skin growth of body, arms, or legs, 1.1-2.0 cm	14	11	$320.00	$126.44
11602 Removal of cancer skin growth of body, arms, or legs, 1.1-2.0 cm	13	12	$380.00	$185.81

Medical Specialties & State Licenses

CMS Verified: 2024-08-21

Surgery - Plastic and Reconstructive Surgery Primary Specialty

NUCC Taxonomy Code: 2086S0122X

State License IL 125-050203

A surgeon who specializes in plastic and reconstructive surgery.

Practice Associates & Co-Workers

Healthcare professionals and specialists practicing at this location or sharing practice phone/fax

3 Associated Practitioners

Ashley Noeth , FNP-BC

Nurse Practitioner - Family

NPI 1548719651

Family Nurse Practitioner (Board Certified)

Taylor Terveer , FNP

Nurse Practitioner - Family

NPI 1861147282

Family Nurse Practitioner

Laura Mckinzie , NP

Nurse Practitioner

NPI 1922348002

Nurse Practitioner

Career & Practice History Timeline

Chronological log of verified NPI updates, location relocations, credentials, and registry changes

8 Historical Events

📍

Updated Practice Location August 21, 2024

Registered at 4955 S STATE ROUTE 159 STE 1, GLEN CARBON, IL 620341907 (Tel: 6182887855)

📍

Updated Business Mailing Address August 21, 2024

Registered at 4955 S STATE ROUTE 159 STE 1, GLEN CARBON, IL 620341907 (Tel: 6182887855)

✅

NPI Profile Active January 16, 2013

NPI status registered as active in NPPES database

📍

Updated Practice Location January 16, 2013

Registered at 6812 STATE ROUTE 162, MARYVILLE, IL 620628553 (Tel: 6182887855)

📍

Updated Business Mailing Address January 16, 2013

Registered at 6810 STATE ROUTE 162, BOX 215, MARYVILLE, IL 620628501 (Tel: 6183916405)

👤

Provider Name / Credentials Updated January 16, 2013

Recorded as RYAN DIEDERICH, MD

🎓

Medical Taxonomy / Specialty Registered (Primary Specialty) January 16, 2013

Surgery (License #125-050203 in IL)

🟢

Initial NPI Registration & Enumeration May 03, 2007

First registered as active Individual Practitioner in NPPES Database.

Patient & Community Reviews

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NPI Administrative Meta

NPI Number: 1942422498

Entity Type:

Individual Provider Physician, Nurse Practitioner, or Solo Healthcare Professional (Type 1 NPI)

Enumeration Date: May 03, 2007

Last Update: August 21, 2024

Sole Proprietor: No

Update or Correct Profile

Mailing Address

4955 S State Route 159 Ste 1

Glen Carbon, IL 620341907

Phone: 6182887855

Public Domain Record This profile contains public domain information published by CMS and NPPES under the Freedom of Information Act (FOIA).

⚠️ Medical Disclaimer

This directory listing is for informational purposes only and does not constitute medical advice, diagnosis, or physician endorsement. If you are experiencing a medical emergency, please call 911 immediately.