Collin Anders Dietrich, MD

Primary specialty

Pediatrics PhysicianTaxonomy code 208000000X

License

2024-02366 Issued in NC

Practice address

101 W Medical Park Dr
Lexington, NC 27292-6773

Phone

(336) 249-4911

NPI assigned

Apr 7, 2021

Sex

Male

Sole proprietor

No

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

Specialties & licenses 2

Addresses

Medicare fee-for-service enrollment

Enrolled in NC

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

Doctor of Medicine

State licenses

Interoperability endpoints

• Direct secure messaging: cdietrich2755790@carolinashealthcaresystem.direct-ci.com

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

{
    "created_epoch": "1617753600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1725926400000",
    "number": "1548849490",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "101 W MEDICAL PARK DR",
            "city": "LEXINGTON",
            "state": "NC",
            "postal_code": "272926773",
            "telephone_number": "336-249-4911"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "101 W MEDICAL PARK DR",
            "city": "LEXINGTON",
            "state": "NC",
            "postal_code": "272926773",
            "telephone_number": "336-249-4911"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "1 Medical Center Blvd",
            "address_purpose": "LOCATION",
            "city": "Winston Salem",
            "state": "NC",
            "postal_code": "271570001",
            "country_code": "US",
            "telephone_number": "336-716-2011",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "DIETRICH",
        "first_name": "COLLIN",
        "middle_name": "ANDERS",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2021-04-07",
        "last_updated": "2024-09-10",
        "certification_date": "2024-09-10",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "390200000X",
            "taxonomy_group": "",
            "desc": "Student in an Organized Health Care Education/Training Program",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "208000000X",
            "taxonomy_group": "",
            "desc": "Pediatrics",
            "state": "NC",
            "license": "2024-02366",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Kimberly Elaine Debty
• Roland Dela Cruz, PT
• Sharon Lynn Dennis, RN
• Destiny Home Health Services, Inc.
• Marybeth Gail Diaz, PA-C, DMSC
• Marie M. Dinges, FNP-C
• Samantha Dawn Dollarhite, LCSWA
• Colene Elizabeth Donathan
• Deborah Dorsett, MOT, OTR/L
• Caleb Frank Reece Doub, M.S., LCAS

• Pediatrics Physician in Lexington, NC
• Providers in Lexington, NC by specialty
• Pediatrics Physician in North Carolina

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 10, 2024; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.