Active NPI
Richard Grenville Diedrich, MD
- Pediatrics Physician
- Farmington, NM
National Provider Identifier
1255363149
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Pediatrics Physician
- License
- NM 80-29
- Practice address
- 1001 D W. Broadway
Farmington, NM 87401 - Phone
- (505) 327-4796
- NPI assigned
- Jul 7, 2006
- Last updated
- Jul 8, 2007
- 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 |
|---|---|---|---|---|
| Pediatrics Physician | 208000000X | NM 80-29 | NM | Primary |
Addresses
Primary practice location
1001 D W. Broadway
Farmington, NM 87401
Mailing address
116 Pine River Ranch Cir
Bayfield, CO 81122-9325
Phone (970) 884-4831
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 27870 | Medicaid | NM |
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
- Doctor of Medicine
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| NM 80-29 | NM | MD | Pediatrics Physician |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1152230400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1183852800000",
"number": "1255363149",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "116 PINE RIVER RANCH CIR",
"city": "BAYFIELD",
"state": "CO",
"postal_code": "811229325",
"telephone_number": "970-884-4831"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1001 D W. BROADWAY",
"city": "FARMINGTON",
"state": "NM",
"postal_code": "87401",
"telephone_number": "505-327-4796"
}
],
"practiceLocations": [],
"basic": {
"last_name": "DIEDRICH",
"first_name": "RICHARD",
"middle_name": "GRENVILLE",
"credential": "MD",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2006-07-07",
"last_updated": "2007-07-08",
"status": "A"
},
"taxonomies": [
{
"code": "208000000X",
"taxonomy_group": "",
"desc": "Pediatrics",
"state": "NM",
"license": "NM 80-29",
"primary": true
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "27870",
"state": "NM"
}
],
"endpoints": [],
"other_names": []
}Other providers in Farmington, NM
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 8, 2007; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.