NPIMap

Organization Active NPI

Shemiah R Derrick Inc.

  • Adult Mental Health Clinic/Center
  • Chicago, IL
National Provider Identifier
1003412909
Registry record updated Dec 7, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
Adult Mental Health Clinic/CenterTaxonomy code 261QM0850X
Legal business name
SHEMIAH R DERRICK INC.
Practice address
6127 S University Ave Ste 109
Chicago, IL 60637-5894
Phone
(773) 424-2007
NPI assigned
Dec 7, 2020
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Dec 7, 2020

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

Authorized official

Name
Mrs. Shemiah R. Derrick, LPC, CADCNPI 1518419027
Title
President & Owner
Phone
(773) 424-2007

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Mental Health Clinic/Center (Including Community Mental Health Center) 261QM0801X
Adult Mental Health Clinic/Center 261QM0850X Primary

Addresses

Primary practice location

6127 S University Ave Ste 109
Chicago, IL 60637-5894

Mailing address

6127 S University Ave Ste 109
Chicago, IL 60637-5894
Phone (773) 424-2007

Other names 1

  • Profound Peace Psychotherapy Collective Doing business as

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in IL

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20250121001555 IL Part B Supplier - Clinic/Group Practice 5496284408 Receives reassigned benefits from 1 practitioner
Practice locations: Chicago, IL

National Provider Directory

National Provider Directory

Locations

6127 S University Ave
Ste 109
Chicago, IL 60637
Phone (773) 234-9905

Practitioners & affiliated clinicians

Practitioners 7

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

NPI Registry JSON

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

{
    "created_epoch": "1607299200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1607299200000",
    "number": "1003412909",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "6127 S UNIVERSITY AVE STE 109",
            "city": "CHICAGO",
            "state": "IL",
            "postal_code": "606375894",
            "telephone_number": "773-424-2007"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "6127 S UNIVERSITY AVE STE 109",
            "city": "CHICAGO",
            "state": "IL",
            "postal_code": "606375894",
            "telephone_number": "773-424-2007"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "SHEMIAH R DERRICK INC.",
        "organizational_subpart": "NO",
        "enumeration_date": "2020-12-07",
        "last_updated": "2020-12-07",
        "certification_date": "2020-12-07",
        "status": "A",
        "authorized_official_last_name": "DERRICK",
        "authorized_official_first_name": "SHEMIAH",
        "authorized_official_middle_name": "R.",
        "authorized_official_title_or_position": "PRESIDENT & OWNER",
        "authorized_official_telephone_number": "773-424-2007",
        "authorized_official_name_prefix": "Mrs.",
        "authorized_official_credential": "LPC, CADC"
    },
    "taxonomies": [
        {
            "code": "261QM0801X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Mental Health (Including Community Mental Health Center)",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "261QM0850X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Adult Mental Health",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Profound Peace Psychotherapy Collective",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Chicago, IL

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 7, 2020; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.