Individual provider Active NPI

Claude Gregory Diettrich, CRNA

  • Certified Registered Nurse Anesthetist
  • Roanoke Rapids, NC
National Provider Identifier
1689787640
Registry record updated Apr 1, 2025
On this page

Key facts

NPPES NPI Registry
Primary specialty
Certified Registered Nurse AnesthetistTaxonomy code 367500000X
License
0024164474 Issued in VA
Practice address
104 Gail Dr
Roanoke Rapids, NC 27870-9202
Phone
(252) 533-0413
NPI assigned
Aug 16, 2006
Last updated
Apr 1, 2025By the provider in NPPES
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Apr 1, 2025

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Certified Registered Nurse Anesthetist 367500000X 044226 NC
Certified Registered Nurse Anesthetist 367500000X 0024164474 VA Primary

Addresses

Primary practice location

104 Gail Dr
Roanoke Rapids, NC 27870-9202

Mailing address

104 Gail Dr
Roanoke Rapids, NC 27870-9202
Phone (252) 533-0413

Other identifiers 1

IdentifierTypeStateIssuer
8051649MedicaidNC

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in NC, VA2 enrollments

Enrollment records 2

Enrollment IDStateProvider typePAC IDDetails
I20040928001158 NC Practitioner - Certified Registered Nurse Anesthetist (Crna) 9739158593
I20141226000318 VA Practitioner - Certified Registered Nurse Anesthetist (Crna) 9739158593 Reassigns benefits to 2 organizations

Care Compare profile

Medicare Care Compare
Specialty
Certified Registered Nurse Anesthetist (Crna)
Education
Other, 1993
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices

Practice addresses (Care Compare)

19455 Deerfield Ave
Suite 204
Leesburg, VA 20176-8102
Phone (703) 724-9950

727 N Main St
Emporia, VA 23847-1274
Phone (434) 348-4400

Hospital & facility affiliations

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Certified Registered Nurse

State licenses

LicenseStateTypeSpecialty
044226NCMDCertified Registered Nurse Anesthetist

Practice roles

OrganizationSpecialtyStatusNew patients
American Anesthesiology of Virginia, PC CurrentSince Apr 1, 2021 Accepting new patients
American Anesthesiology of Virginia PC CurrentSince Apr 1, 2021 Accepting new patients
Vidant Medical Group LLC CurrentSince Jun 1, 2021 Accepting new patients
Medstream Anesthesia PLLC Nurse Anesthetist, Certified Registered CurrentSince Nov 10, 2014 Accepting new patients

Locations

700 Academy St S
Ahoskie, NC 27910
Phone (252) 209-3614

401 N Main St
Kenansville, NC 28349
Phone (910) 296-0941

250 Smith Church Rd
Roanoke Rapids, NC 27870
Phone (252) 308-9699

111 Hospital Dr
Tarboro, NC 27886
Phone (252) 641-7700

310 S McCaskey Rd
Williamston, NC 27892
Phone (252) 809-6133

19455 Deerfield Ave
Ste 204
Leesburg, VA 20176
Phone (703) 724-9950

200 Medical Park Blvd
Petersburg, VA 23805
Phone (804) 765-5000

6801 Governor Gc Peery Hwy
Richlands, VA 24641
Phone (276) 523-8600

Organizations & group practices 4

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 1

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": "1155686400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1743465600000",
    "number": "1689787640",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "104 GAIL DR",
            "city": "ROANOKE RAPIDS",
            "state": "NC",
            "postal_code": "278709202",
            "telephone_number": "252-533-0413"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "104 GAIL DR",
            "city": "ROANOKE RAPIDS",
            "state": "NC",
            "postal_code": "278709202",
            "telephone_number": "252-533-0413"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "DIETTRICH",
        "first_name": "CLAUDE",
        "middle_name": "GREGORY",
        "name_prefix": "Mr.",
        "credential": "CRNA",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-08-16",
        "last_updated": "2025-04-01",
        "certification_date": "2025-04-01",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "367500000X",
            "taxonomy_group": "",
            "desc": "Nurse Anesthetist, Certified Registered",
            "state": "NC",
            "license": "044226",
            "primary": false
        },
        {
            "code": "367500000X",
            "taxonomy_group": "",
            "desc": "Nurse Anesthetist, Certified Registered",
            "state": "VA",
            "license": "0024164474",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "8051649",
            "state": "NC"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Roanoke Rapids, NC

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 1, 2025; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.