Individual provider Active NPI

Michele Deiterich, CRNA

  • Certified Registered Nurse Anesthetist
  • Ephrata, PA
National Provider Identifier
1104249093
Registry record updated May 15, 2025
On this page

Key facts

NPPES NPI Registry
Primary specialty
Certified Registered Nurse AnesthetistTaxonomy code 367500000X
License
RN296687L Issued in PA
Practice address
169 Martin Ave
Ephrata, PA 17522-1724
Phone
(717) 733-0311
Fax
(717) 721-5861
NPI assigned
Jan 28, 2014
Sex
Female
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on May 15, 2025

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Certified Registered Nurse Anesthetist 367500000X RN296687L PA Primary

Addresses

Primary practice location

169 Martin Ave
Ephrata, PA 17522-1724

Mailing address

601 Memory LN
York, PA 17402-2231
Phone (717) 851-1405

Other practice location 1

252 S 4th St
Lebanon, PA 17042-6111
Phone (717) 270-7500

Other practice location 2

25 Monument Rd
York, PA 17403-5060
Phone (717) 741-8250

Other practice location 3

1001 S George St
York, PA 17403-3676
Phone (717) 812-7687

Other practice location 4

4150 Barrett Blvd
Ephrata, PA 17522-8979
Phone (717) 859-5160

Other practice location 5

35 Erick Rd
Lancaster, PA 17601-3111
Phone (717) 690-0811

Organizations & group practices 14

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

View all 14

Hospital & facility affiliations 7

Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.

Care Compare profile

Medicare Care Compare
Specialty
Certified Registered Nurse Anesthetist (Crna)
Education
Other, 2013
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Wellspan Medical Group 2,438 clinicians

Practice addresses (Care Compare)

1001 S George St
York, PA 17403-3676
Phone (717) 812-7687

Hospital & facility affiliations

  • Wellspan Ephrata Community Hospital Hospital, Ephrata, PA, CCN 390225
  • Wellspan Good Samaritan Hospital Hospital, Lebanon, PA, CCN 390066

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in PA

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20140602002126 PA Practitioner - Certified Registered Nurse Anesthetist (Crna) 7214150705 Reassigns benefits to 2 organizations

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Certified Registered Nurse

State licenses

LicenseStateTypeSpecialty
RN296687LPAMDCertified Registered Nurse Anesthetist

Practice roles

OrganizationSpecialtyStatusNew patients
Wellspan Medical Group Current Accepting new patients
Tower Health Medical Group CurrentSince Jul 1, 2017 Accepting new patients
Wellspan Medical Group CurrentSince Jun 12, 2023 Accepting new patients
Tower Health Medical Group Current Accepting new patients
Tower Health Medical Group CurrentSince Jul 1, 2017 Accepting new patients
Wellspan Medical Group CurrentSince Jun 12, 2023 Accepting new patients

Locations

4150 Barrett Blvd
Ephrata, PA 17522
Phone (717) 738-5648

169 Martin Ave
Ephrata, PA 17522
Phone (717) 733-0311

35 Erick Rd
Lancaster, PA 17601
Phone (717) 690-0785

252 S 4th St
Lebanon, PA 17042
Phone (717) 270-7500

6 Spruce St
West Reading, PA 19611
Phone (484) 628-8269

301 S 7th Ave
Ste 130
West Reading, PA 19611
Phone (610) 988-4630

2610 Keiser Blvd
Wyomissing, PA 19610
Phone (484) 628-9127

1600 S George St
York, PA 17403
Phone (717) 848-3615

3421 Concord Rd
York, PA 17402
Phone (717) 851-2441

1001 S George St
York, PA 17403
Phone (717) 812-7687

601 Memory Ln
York, PA 17402
Phone (717) 851-6670

25 Monument Rd
Ste 270
York, PA 17403
Phone (717) 741-8250

NPI Registry JSON

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

{
    "created_epoch": "1390867200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1747267200000",
    "number": "1104249093",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "601 MEMORY LN",
            "city": "YORK",
            "state": "PA",
            "postal_code": "174022231",
            "telephone_number": "717-851-1405"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "169 MARTIN AVE",
            "city": "EPHRATA",
            "state": "PA",
            "postal_code": "175221724",
            "telephone_number": "717-733-0311",
            "fax_number": "717-721-5861"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "252 S 4th St",
            "address_purpose": "LOCATION",
            "city": "Lebanon",
            "state": "PA",
            "postal_code": "170426111",
            "country_code": "US",
            "telephone_number": "717-270-7500",
            "fax_number": "717-228-1642",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "25 Monument Rd",
            "address_purpose": "LOCATION",
            "city": "York",
            "state": "PA",
            "postal_code": "174035060",
            "country_code": "US",
            "telephone_number": "717-741-8250",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "1001 S George St",
            "address_purpose": "LOCATION",
            "city": "York",
            "state": "PA",
            "postal_code": "174033676",
            "country_code": "US",
            "telephone_number": "717-812-7687",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "4150 Barrett Blvd",
            "address_purpose": "LOCATION",
            "city": "Ephrata",
            "state": "PA",
            "postal_code": "175228979",
            "country_code": "US",
            "telephone_number": "717-859-5160",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "35 Erick Rd",
            "address_purpose": "LOCATION",
            "city": "Lancaster",
            "state": "PA",
            "postal_code": "176013111",
            "country_code": "US",
            "telephone_number": "717-690-0811",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "DEITERICH",
        "first_name": "MICHELE",
        "credential": "CRNA",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2014-01-28",
        "last_updated": "2025-05-15",
        "certification_date": "2025-05-15",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "367500000X",
            "taxonomy_group": "",
            "desc": "Nurse Anesthetist, Certified Registered",
            "state": "PA",
            "license": "RN296687L",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Ephrata, PA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 15, 2025; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.