Individual provider Active NPI

Nathalie K Diethrich, PMHNP

  • Psychiatric/Mental Health Nurse Practitioner
  • Decatur, IL
National Provider Identifier
1104374727
Registry record updated Sep 30, 2025
On this page

Key facts

NPPES NPI Registry
Primary specialty
Psychiatric/Mental Health Nurse PractitionerTaxonomy code 363LP0808X
License
277001744 Issued in IL
Practice address
151 N Main St
Decatur, IL 62523-1206
Phone
(217) 362-6262
Fax
(217) 362-6290
NPI assigned
Sep 12, 2016
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Sep 30, 2025

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

Specialties & licenses 3

Specialty (taxonomy)CodeLicenseStatePrimary
Psychiatric/Mental Health Nurse Practitioner 363LP0808X 277001744 IL Primary
Psychiatric/Mental Health Nurse Practitioner 363LP0808X 377001689 IL
Psychiatric/Mental Health Nurse Practitioner 363LP0808X 209.014716 IL

Addresses

Primary practice location

151 N Main St
Decatur, IL 62523-1206

Mailing address

151 N Main St
Decatur, IL 62523-1206
Phone (217) 362-6262

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in IL
Eligible to order & refer
  • Part B services: Yes
  • Medical equipment: Yes
  • Home health: Yes
  • Power mobility devices: Yes
  • Hospice: No
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20170410001898 IL Practitioner - Nurse Practitioner 2860778651 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Nurse Practitioner
Education
Other, 2006
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Telehealth
Offers telehealth services
Group practices
Heritage Behavioral Health Center, Inc.Group PAC ID 0547208951, 20 clinicians

Practice addresses (Care Compare)

151 N Main St
Decatur, IL 62523-1206
Phone (217) 362-6262

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
209.014716ILMDPsychiatric/Mental Health Nurse Practitioner
377001689ILMDPsychiatric/Mental Health Nurse Practitioner

Practice roles

OrganizationSpecialtyStatusNew patients
Heritage Behavioral Health Center Inc. CurrentSince Sep 7, 2019 Accepting new patients
Heritage Behavioral Health Center, Inc. CurrentSince Sep 7, 2019 Accepting new patients
Heritage Behavioral Health Center Past Accepting new patients
Heritage Behavioral Health Center, Inc. Past Accepting new patients
Heritage Behavioral Health Center Past Accepting new patients
Heritage Behavioral Health Center Inc. Past Accepting new patients
Heritage Behavioral Health Center, Inc Past Accepting new patients
Heritage Behavioral Health Center Past Accepting new patients
Heritage Behavioral Health Center, Inc Past Accepting new patients
Heritage Behavioral Health Center Past Accepting new patients
Heritage Behavioral Health Center Inc. Past Accepting new patients
Heritage Behavioral Health Center Inc. Past Accepting new patients

Locations

140 Sunrise Ct
Clinton, IL 61727
Phone (217) 570-0900

2965 N Main St
Decatur, IL 62526
Phone (217) 464-1250

788 E Clay St
Decatur, IL 62521

243 W Cerro Gordo St
Decatur, IL 62522
Phone (217) 422-3940

151 N Main St
Decatur, IL 62523
Phone (217) 420-4776

Organizations & group practices 12

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.

NPI Registry JSON

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

{
    "created_epoch": "1473638400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1759190400000",
    "number": "1104374727",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "151 N MAIN ST",
            "city": "DECATUR",
            "state": "IL",
            "postal_code": "625231206",
            "telephone_number": "217-362-6262",
            "fax_number": "217-362-6290"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "151 N MAIN ST",
            "city": "DECATUR",
            "state": "IL",
            "postal_code": "625231206",
            "telephone_number": "217-362-6262",
            "fax_number": "217-362-6290"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "DIETHRICH",
        "first_name": "NATHALIE",
        "middle_name": "K",
        "credential": "PMHNP",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2016-09-12",
        "last_updated": "2025-09-30",
        "certification_date": "2025-09-30",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LP0808X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Psychiatric/Mental Health",
            "state": "IL",
            "license": "277001744",
            "primary": true
        },
        {
            "code": "363LP0808X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Psychiatric/Mental Health",
            "state": "IL",
            "license": "377001689",
            "primary": false
        },
        {
            "code": "363LP0808X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Psychiatric/Mental Health",
            "state": "IL",
            "license": "209.014716",
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Decatur, IL

Sources for this page

Verify at the official NPI Registry.