Active NPI
Christopher Wayne Dietrich, PA
- Physician Assistant
- Indianapolis, IN
National Provider Identifier
1013967462
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Physician Assistant
- License
- 10000684A
- Practice address
- 8333 Naab Rd
Suite 250
Indianapolis, IN 46260-5924 - Phone
- (317) 396-1300
- Fax
- (317) 396-1346
- NPI assigned
- May 10, 2006
- Sex
- Male
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Physician Assistant | 363A00000X | 10000684A | IN | Primary |
Addresses
Primary practice location
8333 Naab Rd
Suite 250
Indianapolis, IN 46260-5924
Mailing address
8333 Naab Rd
Suite 250
Indianapolis, IN 46260-5924
Phone (317) 396-1300
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
- Credentials
- Physician Assistant
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 10000684A | IN | MD | Physician Assistant |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1147219200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1370822400000",
"number": "1013967462",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "8333 NAAB RD",
"address_2": "SUITE 250",
"city": "INDIANAPOLIS",
"state": "IN",
"postal_code": "462605924",
"telephone_number": "317-396-1300",
"fax_number": "317-396-1346"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "8333 NAAB RD",
"address_2": "SUITE 250",
"city": "INDIANAPOLIS",
"state": "IN",
"postal_code": "462605924",
"telephone_number": "317-396-1300",
"fax_number": "317-396-1346"
}
],
"practiceLocations": [],
"basic": {
"last_name": "DIETRICH",
"first_name": "CHRISTOPHER",
"middle_name": "WAYNE",
"name_prefix": "Mr.",
"credential": "PA",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2006-05-10",
"last_updated": "2013-06-10",
"status": "A"
},
"taxonomies": [
{
"code": "363A00000X",
"taxonomy_group": "",
"desc": "Physician Assistant",
"state": "IN",
"license": "10000684A",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Indianapolis, IN
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 10, 2013; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.