Gary D Diederich, M.D.

Primary specialty

Family Medicine PhysicianTaxonomy code 207Q00000X

License

6515 Issued in NH

Practice address

859 Lake St
Bristol, NH 03222-4506

Phone

(603) 744-6200

Fax

(603) 744-9024

NPI assigned

Jun 8, 2006

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

Other identifiers 2

Medicare fee-for-service enrollment

Enrolled in NH

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

Practice roles

Locations

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

• Concord Hospital, Inc.

  • Emergency Medicine Physician
  • Concord, NH
  • NPI 1194778571
  NPD

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

{
    "created_epoch": "1149724800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1196380800000",
    "number": "1720029259",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "101 BOULDER POINT DR",
            "address_2": "SUITE 1",
            "city": "PLYMOUTH",
            "state": "NH",
            "postal_code": "03264",
            "telephone_number": "603-536-4000",
            "fax_number": "603-536-4001"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "859 LAKE ST",
            "city": "BRISTOL",
            "state": "NH",
            "postal_code": "032224506",
            "telephone_number": "603-744-6200",
            "fax_number": "603-744-9024"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "DIEDERICH",
        "first_name": "GARY",
        "middle_name": "D",
        "credential": "M.D.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-06-08",
        "last_updated": "2007-11-30",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "NH",
            "license": "6515",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "80000321",
            "state": "NH"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "MEDICARE GROUP",
            "identifier": "RE4060",
            "state": "NH"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Rexford Forrest Burnette, PH.D.
• Bonnie K Colby
• Jessica Croteau, PA
• Amy Sue Delucia, OTA
• Katherine S Desloges, MED, NCSP
• Mia Briana Dimeglio
• Peter G Doane, MD
• Cassie L Dorval, DPT
• Robert Wilfred Dumond, LCMHC, CCMHC, DIPCFC
• Tina Easley, PHARMD

• Family Medicine Physician in Bristol, NH
• Providers in Bristol, NH by specialty
• Family Medicine Physician in New Hampshire

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 30, 2007; 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.