Kenneth Anthony Dietrich, M.D., MBA

Primary specialty

Pediatric Critical Care Medicine PhysicianTaxonomy code 2080P0203X

License

27133 Issued in WA

Practice address

600 E Main St
Elma, WA 98541-9560

Phone

(360) 346-2240

Fax

(360) 346-2192

NPI assigned

May 5, 2006

Last updated

Apr 4, 2019By the provider in NPPES

Sex

Male

Sole proprietor

No

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

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Enrolled in WA

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: Yes
• Power mobility devices: Yes
• Hospice: Yes

Green means eligible to order or refer.

Enrollment records 1

Medicare enrollment (NPD)

Enrolled

Credentials

Master of Business Administration, Doctor of Medicine

State licenses

Practice roles

Locations

All facility ownership & control disclosures 3

Facilities whose Medicare enrollment lists this provider’s PECOS associate ID as an owner or managing party.

Owned or controlled facilities with NPI records 3

Facilities whose Medicare enrollment lists this provider as an owner, officer, director or managing party.

• Grays Harbor County Public Hospital District No 1

  dba Summit Pacific Health Clinic

  • Rural Health Clinic/Center
  • Elma, WA
  • NPI 1083202907

  Corporate Officer

  CMS ownership
• Grays Harbor County Public Hospital District No 1

  dba Summit Pacific Medical Center

  • Medicare Defined Swing Bed Hospital Unit
  • Elma, WA
  • NPI 1750554366

  Corporate Officer

  CMS ownership
• Grays Harbor County Public Hospital District No. 1

  dba dba-McCleary Healthcare Clinic

  • Rural Health Clinic/Center
  • McCleary, WA
  • NPI 1255401683

  Corporate Officer

  CMS ownership

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

• Grays Harbor County Public Hospital District No 1

  dba Summit Pacific Medical Center

  • Critical Access Hospital
  • Elma, WA
  • NPI 1740211028
  Medicare reassignment NPD
• Grays Harbor County Public Hospital District No 1

  dba Summit Pacific Health Clinic

  • Rural Health Clinic/Center
  • Elma, WA
  • NPI 1083202907
  NPD

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

{
    "created_epoch": "1146787200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1554336000000",
    "number": "1245288752",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "600 E MAIN ST",
            "city": "ELMA",
            "state": "WA",
            "postal_code": "985419560",
            "telephone_number": "360-346-2240",
            "fax_number": "360-346-2192"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "600 E MAIN ST",
            "city": "ELMA",
            "state": "WA",
            "postal_code": "985419560",
            "telephone_number": "360-346-2240",
            "fax_number": "360-346-2192"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "314 Martin Luther King Jr Way",
            "address_2": "Suite 9",
            "address_purpose": "LOCATION",
            "city": "Tacoma",
            "state": "WA",
            "postal_code": "984054250",
            "country_code": "US",
            "telephone_number": "253-403-1511",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "DIETRICH",
        "first_name": "KENNETH",
        "middle_name": "ANTHONY",
        "name_prefix": "Dr.",
        "credential": "M.D., MBA",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-05-05",
        "last_updated": "2019-04-04",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "2080P0203X",
            "taxonomy_group": "",
            "desc": "Pediatrics, Pediatric Critical Care Medicine",
            "state": "WA",
            "license": "27133",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Jennie Coic, COTA/L
• Columbia Capital Medical Center, LP (The Clinic at Elma)
• Michelle Contreras
• Kristi Lynn Covey, OTRL
• Zoe Daee
• Kristin Rain Dineen, LMP
• Stephen L Drasnin, MD
• East Grays Harbor Fire and Rescue
• Edwards & Ketcher, PLLC (Elma Family Dental)
• Karissa Ann Ellis, D.O.

• Pediatric Critical Care Medicine Physician in Elma, WA
• Providers in Elma, WA by specialty
• Pediatric Critical Care Medicine Physician in Washington

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 4, 2019; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; facility enrollments, owners and changes of ownership; Provider of Services certification data; Order and Referring.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.