NPIMap

Individual provider Active NPI

Christine Diederich, NP

  • Family Nurse Practitioner
  • Sartell, MN
National Provider Identifier
1447212345
Registry record updated Jan 31, 2017
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Nurse PractitionerTaxonomy code 363LF0000X
License
R128637-3 Issued in MN
Practice address
100 2ND St S
Sartell, MN 56377-1977
Phone
(320) 251-2600
Fax
(320) 251-4763
NPI assigned
Apr 5, 2006
Last updated
Jan 31, 2017By the provider in NPPES
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jan 31, 2017

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Family Nurse Practitioner 363LF0000X R128637-3 MN Primary

Addresses

Primary practice location

100 2ND St S
Sartell, MN 56377-1977

Mailing address

100 2ND St S
Sartell, MN 56377-1977
Phone (320) 251-2600

Other identifiers 1

IdentifierTypeStateIssuer
376718300MedicaidMN

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in MN
Eligible to order & refer
  • Part B services
  • Medical equipment
  • Home health
  • Power mobility devices
  • Hospice
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20110428000482 MN Practitioner - Nurse Practitioner 5193900579 Reassigns benefits to 2 organizations

Care Compare profile

Medicare Care Compare
Specialty
Nurse Practitioner
Education
Other, 2010
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
St Josephs Medical CenterGroup PAC ID 8224948443, 238 clinicians

Practice addresses (Care Compare)

301 2ND Ave NW
Staples, MN 56479-3336
Phone (218) 894-7870

Hospital & facility affiliations

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Nurse Practitioner

Practice roles

OrganizationSpecialtyStatusNew patients
Brainerd Medical Center Inc CurrentSince Dec 15, 2016 Accepting new patients
St Joseph's Medical Center CurrentSince Dec 15, 2016 Accepting new patients
St. Joseph's Medical Center Current Accepting new patients
St. Joseph's Medical Center CurrentSince Dec 15, 2016 Accepting new patients
Brainerd Medical Center Inc. CurrentSince Dec 15, 2016 Accepting new patients

Locations

13060 Isle Dr
Brainerd, MN 56425
Phone (218) 454-5920

2024 S 6th St
Brainerd, MN 56401
Phone (218) 828-2880

523 N 3rd St
Brainerd, MN 56401
Phone (218) 828-7394

301 2nd Ave NW
Staples, MN 56479
Phone (218) 894-7870

Organizations & group practices 5

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.

Hospital & facility affiliations 10

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

NPI Registry JSON

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

{
    "created_epoch": "1144195200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1485820800000",
    "number": "1447212345",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "100 2ND ST S",
            "city": "SARTELL",
            "state": "MN",
            "postal_code": "563771977",
            "telephone_number": "320-251-2600",
            "fax_number": "320-251-4763"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "100 2ND ST S",
            "city": "SARTELL",
            "state": "MN",
            "postal_code": "563771977",
            "telephone_number": "320-251-2600",
            "fax_number": "320-251-4763"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "DIEDERICH",
        "first_name": "CHRISTINE",
        "credential": "NP",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2006-04-05",
        "last_updated": "2017-01-31",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LF0000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Family",
            "state": "MN",
            "license": "R128637-3",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "376718300",
            "state": "MN"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Sartell, MN

Sources for this page

Verify at the official NPI Registry.