JORDAN DIETRICH MD
NPI 1255081345
Student in an Organized Health Care Education/Training Program in Lebanon, NH

Active since March 24, 2022PECOS EnrolledAccepts Medicare Assignment
1 MEDICAL DR DEPT OF, LEBANON, NH 03756(603) 650-5000 Get Directions Write a Review

NPPES record last updated: May 6, 2026. Verified against the NPPES registry weekly; last sync: July 26, 2026.

Record update history: May 6, 2026, Nov 6, 2024 (2 updates tracked since 2024).

About Jordan Dietrich Md NPPES

Official registry information on file with the National Plan and Provider Enumeration System.

JORDAN DIETRICH MD (NPI 1255081345) is an individual student in an organized health care education/training program in Lebanon, New Hampshire and active in the NPI registry since March 2022. He is enrolled in Medicare PECOS and is a graduate of Other (2022).

NPPES Registry Identity

NPI1255081345
Entity TypeIndividualMale
Primary Taxonomy390200000X
Provider Legal NameJORDAN DIETRICHCredential: MD
Location Address1 MEDICAL DR DEPT OFLebanon, NH 03756-1000
Mailing Address1 Medical Dr Dept OfLebanon, NH 03756-1000
Sole ProprietorNo
Medical School CMSOtherGraduated 2022
Enumeration DateMarch 24, 2022
Last NPPES UpdateMay 6, 20262 updates tracked since enumeration
NPPES CertifiedMay 6, 2026
NPI 1255081345 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses 2

Taxonomy Code390200000X
Definition

An individual who is enrolled in an organized health care education/training program leading to a degree, certification, registration, and/or licensure to provide health care.

Also ListedPsychiatry & Neurology · PsychiatryTaxonomy 2084P0800X · License 33439 (NH)
1 MEDICAL DR DEPT OF, Lebanon, NH 03756

Medicare Participation & PECOS CMS

Medicare enrollment, assignment, and ordering and referring status from the CMS PECOS system.

Medicare Enrollment Status

Enrolled in Medicare and accepts Medicare assignment

Jordan Dietrich Md is registered in PECOS and agrees to accept the Medicare-approved amount as full payment. Medicare patients are not billed beyond the standard deductible and coinsurance.

PECOS PAC ID6507247673
PECOS Enrollment IDI20241126004104
Eligible to Order & Refer Part B Labs & Imaging Durable Medical Equipment Home Health Agency Power Mobility DevicesPer the CMS Ordering and Referring file. Eligibility means Medicare pays claims that this provider orders or refers for these categories.

Other Providers at the Same Location NPPES 20

Providers registered at the same practice address, or within the immediate area, according to the NPPES registry.

Student in an Organized Health Care Education/Training Program
1 MEDICAL DR DEPT OF
LEBANON, NH 03756
Student in an Organized Health Care Education/Training Program
1 MEDICAL DR DEPT OF
LEBANON, NH 03756
Student in an Organized Health Care Education/Training Program
1 MEDICAL DR DEPT OF
LEBANON, NH 03756
Student in an Organized Health Care Education/Training Program
1 MEDICAL DR DEPT OF
LEBANON, NH 03756
Student in an Organized Health Care Education/Training Program
1 MEDICAL DR DEPT OF
LEBANON, NH 03756
Student in an Organized Health Care Education/Training Program
1 MEDICAL DR DEPT OF
LEBANON, NH 03756
Student in an Organized Health Care Education/Training Program
1 MEDICAL DR DEPT OF
LEBANON, NH 03756
Student in an Organized Health Care Education/Training Program
1 MEDICAL DR DEPT OF
LEBANON, NH 03756

Frequently Asked Questions NPPES & CMS

Common questions about this NPI record, answered from the official NPPES registry and CMS datasets shown on this page.

What is Jordan Dietrich's NPI number?

The NPI number for Jordan Dietrich is 1255081345. It was assigned to this individual provider in the NPPES registry on March 24, 2022.

Where is Jordan Dietrich located?

Jordan Dietrich practices at 1 Medical Dr Dept Of, Lebanon, NH 03756. The listed phone number is (603) 650-5000.

What is Jordan Dietrich's specialty?

The primary specialty registered for this NPI is Student in an Organized Health Care Education/Training Program with taxonomy code 390200000X.

Is Jordan Dietrich enrolled in Medicare?

Yes. Jordan Dietrich is registered in the Medicare PECOS system and accepts Medicare assignment, which means accepting the Medicare-approved amount as payment in full for covered services.

When was this NPI record last updated?

The NPPES record for Jordan Dietrich was last updated on May 6, 2026. NPI Profile syncs with the weekly NPPES data releases published by CMS.