Individual provider Active NPI

Jeremy David Diehl, CHW

  • Community Health Worker
  • Lincoln Park, MI
National Provider Identifier
1023904471
Registry record updated Jun 16, 2025
On this page

Key facts

NPPES NPI Registry
Primary specialty
Community Health WorkerTaxonomy code 172V00000X
Practice address
25650 Outer Dr
Lincoln Park, MI 48146-2096
Phone
(313) 561-5100
Fax
(313) 565-0309
NPI assigned
Jun 13, 2025
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jun 16, 2025

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Community Health Worker 172V00000X MI Primary

Addresses

Primary practice location

25650 Outer Dr
Lincoln Park, MI 48146-2096

Mailing address

25650 Outer Dr
Lincoln Park, MI 48146-2096
Phone (313) 561-5100

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)
Not enrolled

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1749772800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1750032000000",
    "number": "1023904471",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "25650 OUTER DR",
            "city": "LINCOLN PARK",
            "state": "MI",
            "postal_code": "481462096",
            "telephone_number": "313-561-5100",
            "fax_number": "313-565-0309"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "25650 OUTER DR",
            "city": "LINCOLN PARK",
            "state": "MI",
            "postal_code": "481462096",
            "telephone_number": "313-561-5100",
            "fax_number": "313-565-0309"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "DIEHL",
        "first_name": "JEREMY",
        "middle_name": "DAVID",
        "credential": "CHW",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2025-06-13",
        "last_updated": "2025-06-16",
        "certification_date": "2025-06-16",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "172V00000X",
            "taxonomy_group": "",
            "desc": "Community Health Worker",
            "state": "MI",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Lincoln Park, MI

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 16, 2025; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.