Chris Diederich, LCSW is a medicare enrolled "Social Worker - Clinical" provider in Indianapolis, Indiana. His current practice location is
2040 N Shadeland Ave, Ste 250, Indianapolis, Indiana. You can reach out to his office (for appointments etc.) via phone at
(317) 355-5009.
Chris Diederich is licensed to practice in Indiana (license number 34004362A) and he also participates in the medicare program. He does not accept medicare assignments directly but he may accept medicare through third-party (refer to Reassignment section below) and may also prescribe medicare part D drugs. His NPI Number is 1821016700.
Healthcare Provider's Profile
| Full Name | Chris Diederich |
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| Gender | Male |
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| Speciality | Social Worker - Clinical |
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| Location | 2040 N Shadeland Ave, Indianapolis, Indiana |
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| Accepts Medicare Assignments | Medicare enrolled and may accept medicare through third-party reassignment. May prescribe medicare part D drugs. |
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NPI Data:
- NPI Number: 1821016700
- Provider Enumeration Date: 07/18/2006
- Last Update Date: 04/12/2018
Medicare PECOS Information:
- PECOS PAC ID: 5395760961
- Enrollment ID: I20051012000827
Medical Identifiers
Medical identifiers for Chris Diederich such as npi, medicare ID, medicare PIN, medicaid, etc.
| Identifier | Type | State | Issuer |
|---|
| 1821016700 | NPI | - | NPPES |
| 000000390191 | Other | IN | ANTHEM BCBS PROVIDER PIN |
Medical Taxonomies and Licenses
| Taxonomy | Type | License (State) | Status |
|---|
| 101YA0400X | Counselor - Addiction (substance Use Disorder) | 39000598A (Indiana) | Secondary |
| 1041C0700X | Social Worker - Clinical | 34004362A (Indiana) | Primary |
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. Chris Diederich allows following entities to bill medicare on his behalf.
| Entity Name | Community Health Network Inc |
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| Entity Type | Part B Supplier - Clinic/group Practice |
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| Entity Identifiers | NPI Number: 1336119478
PECOS PAC ID: 1850203977
Enrollment ID: O20031105000554 |
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| Entity Name | Community Howard Regional Health Inc |
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| Entity Type | Part B Supplier - Clinic/group Practice |
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| Entity Identifiers | NPI Number: 1881947133
PECOS PAC ID: 5890769988
Enrollment ID: O20040824000916 |
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| Entity Name | Adult And Child Mental Health Center Inc |
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| Entity Type | Part B Supplier - Clinic/group Practice |
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| Entity Identifiers | NPI Number: 1154368512
PECOS PAC ID: 3678567898
Enrollment ID: O20050119000497 |
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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. Chris Diederich 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 |
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Chris Diederich, LCSW
6626 E 75th Street, Ste 500,
Indianapolis, IN 46250-2890
Ph: () - | Chris Diederich, LCSW
2040 N Shadeland Ave, Ste 250,
Indianapolis, IN 46219-1711
Ph: (317) 355-5009 |
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