Gordon Dietz, CRNA

Primary specialty

Certified Registered Nurse AnesthetistTaxonomy code 367500000X

License

R103713 Issued in MD

Practice address

224 E Main St
Bertrand Chaffee Hospital
Springville, NY 14141-1443

Phone

(716) 592-2871

Fax

(716) 794-0025

NPI assigned

May 23, 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 3

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Enrolled

Credentials

Certified Registered Nurse

State licenses

Practice roles

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.

• Capital Pain Management & Anesthesia Associates, LLC

  • Anesthesiology Physician
  • La Plata, MD
  • NPI 1407886781
  NPD (past)
• Chambersburg Anesthesia Associates

  • Pain Medicine (Anesthesiology) Physician
  • Chambersburg, PA
  • NPI 1992798516

  Nurse Anesthetist, Certified Registered

  NPD (past)
• Tyra D. Kane

  • Internal Medicine Physician
  • Frederick, MD
  • NPI 1740436245
  NPD (past)

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

{
    "created_epoch": "1148342400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1316131200000",
    "number": "1790730299",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "224 E MAIN ST",
            "address_2": "BERTRAND CHAFFEE HOSPITAL",
            "city": "SPRINGVILLE",
            "state": "NY",
            "postal_code": "141411443",
            "telephone_number": "716-592-2871",
            "fax_number": "716-794-0025"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "224 E MAIN ST",
            "address_2": "BERTRAND CHAFFEE HOSPITAL",
            "city": "SPRINGVILLE",
            "state": "NY",
            "postal_code": "141411443",
            "telephone_number": "716-592-2871",
            "fax_number": "716-794-0025"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "DIETZ",
        "first_name": "GORDON",
        "name_prefix": "Mr.",
        "credential": "CRNA",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-05-23",
        "last_updated": "2011-09-16",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "367500000X",
            "taxonomy_group": "",
            "desc": "Nurse Anesthetist, Certified Registered",
            "state": "MD",
            "license": "R103713",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "007496140 0004",
            "state": "PA"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "GROUP MEDICARE #",
            "identifier": "050514",
            "state": "PA"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "RN LICENSE PA",
            "identifier": "RN326868L",
            "state": "PA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Kenneth Dean Richard Dabolt, RPA-C
• Priscilla K Dale, M.D.
• Dalip K. Khurana, M.D., PLLC
• Tammy Lyn Davis
• Mikelle Demmerley
• Crystal Dimmig
• Jessica Domst, MA
• Debra Ehrig, M.D.
• Jennifer Einarsson, LCSWR
• Katie Fanning

• Certified Registered Nurse Anesthetist in Springville, NY
• Providers in Springville, NY by specialty
• Certified Registered Nurse Anesthetist in New York

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 16, 2011; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.