NPIMap

Individual provider Active NPI

Derek Adrian Andelloux, MD

  • Family Medicine Physician
  • E Greenwich, RI
National Provider Identifier
1013145275
Registry record updated Dec 20, 2013
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Medicine PhysicianTaxonomy code 207Q00000X
License
LP01566 Issued in RI
Practice address
3461 S County TRL
E Greenwich, RI 02818-1465
Phone
(401) 471-6760
Fax
(401) 471-6765
NPI assigned
Jun 26, 2009
Last updated
Dec 20, 2013By the provider in NPPES
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Dec 20, 2013

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Family Medicine Physician 207Q00000X LP01566 RI Primary

Addresses

Primary practice location

3461 S County TRL
E Greenwich, RI 02818-1465

Mailing address

3461 S County TRL
E Greenwich, RI 02818-1465
Phone (401) 471-6760

Other names 1

  • Derek Adrian Mailloux Former name

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in MA
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
I20180418001055 MA Practitioner - Family Practice 0244488823 Reassigns benefits to 2 organizations

Care Compare profile

Medicare Care Compare
Specialty
Family Practice
Education
Other, 2009
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Nantucket Cottage HospitalGroup PAC ID 1759357601, 91 clinicians

Practice addresses (Care Compare)

57 Prospect St
Nantucket, MA 02554-2799
Phone (508) 825-8100

Hospital & facility affiliations

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
LP01566RIMDFamily Medicine Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Nantucket Cottage Hospital CurrentSince May 1, 2018 Accepting new patients
Nantucket Cottage Hospital CurrentSince May 1, 2018 Accepting new patients
Nantucket Physicians Organization Family Medicine CurrentSince Apr 1, 2018 Accepting new patients

Locations

57 Prospect St
Nantucket, MA 02554
Phone (508) 228-1200

Interoperability endpoints

  • Direct secure messaging: andelloux.derek.nch@direct.partners.masshiway.net

Ownership & related parties

All facility ownership & control disclosures 3

Facilities whose Medicare enrollment lists this provider’s PECOS associate ID as an owner or managing party.

FacilityTypeRoleSince
Nantucket Cottage HospitalNantucket, MA, CCN 220177 Hospital Corporate Director Sep 13, 2023
Nantucket Cottage HospitalNantucket, MA, CCN 22U177 Hospital Corporate Director Sep 13, 2023
Nantucket Cottage Medical GroupNantucket, MA, CCN 223979 Rural health clinic Corporate Director Sep 13, 2023

Owned or controlled facilities with NPI records 3

Facilities whose Medicare enrollment lists this provider as an owner, officer, director or managing party.

Organizations & group practices 3

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

Hospital & facility affiliations 4

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": "1245974400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1387497600000",
    "number": "1013145275",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3461 S COUNTY TRL",
            "city": "E GREENWICH",
            "state": "RI",
            "postal_code": "028181465",
            "telephone_number": "401-471-6760",
            "fax_number": "401-471-6765"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3461 S COUNTY TRL",
            "city": "E GREENWICH",
            "state": "RI",
            "postal_code": "028181465",
            "telephone_number": "401-471-6760",
            "fax_number": "401-471-6765"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "ANDELLOUX",
        "first_name": "DEREK",
        "middle_name": "ADRIAN",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2009-06-26",
        "last_updated": "2013-12-20",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "RI",
            "license": "LP01566",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "DEREK",
            "last_name": "MAILLOUX",
            "middle_name": "ADRIAN",
            "code": "1",
            "type": "Former Name"
        }
    ]
}

Other providers in E Greenwich, RI

Sources for this page

Verify at the official NPI Registry.