NPIMap

Individual provider Active NPI

Michael Jeffrey Dietzen, MD

  • Student in an Organized Health Care Education/Training Program
  • Greenville, NC
National Provider Identifier
1912434150
Registry record updated Jul 21, 2022
On this page

Key facts

NPPES NPI Registry
Primary specialty
Student in an Organized Health Care Education/Training ProgramTaxonomy code 390200000X
Practice address
2100 Stantonsburg Rd
Greenville, NC 27834-2818
Phone
(252) 847-4268
NPI assigned
May 18, 2017
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jul 21, 2022

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Student in an Organized Health Care Education/Training Program 390200000X Primary

Addresses

Primary practice location

2100 Stantonsburg Rd
Greenville, NC 27834-2818

Mailing address

2100 Stantonsburg Rd
Greenville, NC 27834-2818
Phone (252) 847-4268

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in NC
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
I20220726003502 NC Practitioner - Diagnostic Radiology 4688944838 Reassigns benefits to 3 organizations

Care Compare profile

Medicare Care Compare
Specialty
Diagnostic Radiology
Education
Brody School of Medicine at East Carolina University, 2017
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Wake Forest Health Network LLCGroup PAC ID 4183538895, 276 clinicians
Wake Forest Baptist Imaging LLCGroup PAC ID 3173681681, 76 clinicians
Wake Forest University Health SciencesGroup PAC ID 4486564952, 2,633 clinicians

Practice addresses (Care Compare)

1814 Westchester Dr
Suite 100
High Point, NC 27262-7369
Phone (336) 802-2175

265 Executive Park Blvd
Winston Salem, NC 27103-1503
Phone (336) 765-5722

Medical Ctr Blvd
Winston Salem, NC 27157-0001
Phone (336) 716-2734

Hospital & facility affiliations

  • North Carolina Baptist Hospital Hospital, Winston-Salem, NC, CCN 340047
  • High Point Regional Health System Hospital, High Point, NC, CCN 340004
  • Wilkes Regional Medical Center Hospital, North Wilkesboro, NC, CCN 340064
  • Watauga Medical Center Hospital, Boone, NC, CCN 340051
  • Moses H. Cone Memorial Hospital, the Hospital, Greensboro, NC, CCN 340091

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Doctor of Medicine

Practice roles

OrganizationSpecialtyStatusNew patients
Wake Forest Health Network, LLC CurrentSince Jun 1, 2025 Accepting new patients
Wake Forest Health Network LLC Current Accepting new patients
Wake Forest Baptist Imaging, LLC CurrentSince Jul 1, 2022 Accepting new patients
Wake Forest University Health Sciences CurrentSince Jul 1, 2022 Accepting new patients
Wake Forest Baptist Imaging LLC CurrentSince Sep 27, 2024 Accepting new patients
Wake Forest Baptist Imaging, LLC CurrentSince Jul 1, 2022 Accepting new patients
Wake Forest Health Network LLC CurrentSince Jun 1, 2025 Accepting new patients

Locations

223 W Ward St
Ste B
Asheboro, NC 27203
Phone (336) 702-1731

223 W Ward St
#B
Asheboro, NC 27203

905 Phillips Ave
High Point, NC 27262
Phone (336) 802-2040

1814 Westchester Dr
Ste 100
High Point, NC 27262
Phone (336) 802-2397

861 Old Winston Rd
Ste 105
Kernersville, NC 27284
Phone (336) 765-5722

Medical Ctr Blvd
Winston Salem, NC 27157
Phone (336) 713-2697

265 Executive Park Blvd
Winston Salem, NC 27103
Phone (336) 765-5722

100 Kimel Forest Dr
Winston Salem, NC 27103
Phone (336) 713-0947

Interoperability endpoints

  • Direct secure messaging: mdietzen2754551@carolinashealthcaresystem.direct-ci.com

Organizations & group practices 7

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.

Hospital & facility affiliations 9

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": "1495065600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1658361600000",
    "number": "1912434150",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2100 STANTONSBURG RD",
            "city": "GREENVILLE",
            "state": "NC",
            "postal_code": "278342818",
            "telephone_number": "252-847-4268"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2100 STANTONSBURG RD",
            "city": "GREENVILLE",
            "state": "NC",
            "postal_code": "278342818",
            "telephone_number": "252-847-4268"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "DIETZEN",
        "first_name": "MICHAEL",
        "middle_name": "JEFFREY",
        "name_prefix": "Dr.",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2017-05-18",
        "last_updated": "2022-07-21",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "390200000X",
            "taxonomy_group": "",
            "desc": "Student in an Organized Health Care Education/Training Program",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Greenville, NC

Sources for this page

Verify at the official NPI Registry.