Jordan Dietrich, MD is a medicare enrolled "Student In An Organized Health Care Education/training Program" physician in Lebanon, New Hampshire. He graduated from medical school in 2022 and has 4 years of diverse experience with area of expertise as Psychiatry. He is a member of the group practice State Of New Hampshire and his current practice location is
1 Medical Dr Dept Of, Lebanon, New Hampshire. You can reach out to his office (for appointments etc.) via phone at
(603) 650-5000.
Jordan Dietrich is licensed to practice in * (Not Available) (license number ) and he also participates in the medicare program. He
accepts medicare assignments (which means he accepts the Medicare-approved amount; you will not be billed for any more than the Medicare deductible and coinsurance) and his NPI Number is 1255081345.
Physician's Profile
| Full Name | Jordan Dietrich |
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| Gender | Male |
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| Speciality | Psychiatry |
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| Experience | 4 Years |
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| Location | 1 Medical Dr Dept Of, Lebanon, New Hampshire |
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| Accepts Medicare Assignments | Yes. He accepts the Medicare-approved amount; you will not be billed for any more than the Medicare deductible and coinsurance. |
Medical Education and Training:
- Jordan Dietrich graduated from medical school in 2022
NPI Data:
- NPI Number: 1255081345
- Provider Enumeration Date: 03/24/2022
- Last Update Date: 11/06/2024
Medicare PECOS Information:
- PECOS PAC ID: 6507247673
- Enrollment ID: I20241126004104
Medical Identifiers
Medical identifiers for Jordan Dietrich such as npi, medicare ID, medicare PIN, medicaid, etc.
| Identifier | Type | State | Issuer |
| 1255081345 | NPI | - | NPPES |
Medical Taxonomies and Licenses
| Taxonomy | Type | License (State) | Status |
| 2084P0800X | Psychiatry & Neurology - Psychiatry | 33439 (New Hampshire) | Secondary |
| 390200000X | Student In An Organized Health Care Education/training Program | (* (Not Available)) | Primary |
Group Practice Association
| Group Practice Name | Group PECOS PAC ID | No. of Members |
| State Of New Hampshire | 3870530579 | 58 |
Medicare Reassignments
Some practitioners may not bill the customers directly but medicare billing happens through clinics / group practice / hospitals where the provider works. Medicare reassignment of benefits is a mechanism by which practitioners allow third parties to bill and receive payment for medicare services performed by them. Jordan Dietrich allows following entities to bill medicare on his behalf.
| Entity Name | State Of New Hampshire |
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| Entity Type | Part B Supplier - Clinic/group Practice |
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| Entity Identifiers | NPI Number: 1861491334 PECOS PAC ID: 3870530579 Enrollment ID: O20050414000166 |
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Medicare Part D Prescriber Enrollment
Any physician or other eligible professional who prescribes Part D drugs must either enroll in the Medicare program or opt out in order to prescribe drugs to their patients with Part D prescription drug benefit plans. Jordan Dietrich is
enrolled with medicare and thus, if eligible, can prescribe medicare part D drugs to patients with medicare part D benefits.
Mailing Address and Practice Location
| Mailing Address | Practice Location Address |
Jordan Dietrich, MD 1 Medical Dr Dept Of, Lebanon, NH 03756-1000 Ph: () - | Jordan Dietrich, MD 1 Medical Dr Dept Of, Lebanon, NH 03756-1000 Ph: (603) 650-5000 |
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