James Lyle Derickson, MD

Primary specialty

Family Medicine PhysicianTaxonomy code 207Q00000X

License

37067 Issued in AZ

Practice address

1852 N Mastick Way
Nogales, AZ 85621

Phone

(520) 281-1550

Fax

(520) 281-4487

NPI assigned

Jul 17, 2006

Sex

Male

Sole proprietor

No

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

Specialties & licenses 1

Addresses

Other identifiers 1

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Medicine

Practice roles

Interoperability endpoints

• FHIR API: https://api.platform.athenahealth.com/1928/brand/1/csg/62/fhir/r4

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

• James L Derickson MD PC

  • Family Medicine Physician
  • Colorado Springs, CO
  • NPI 1427076223
  NPD (past) Authorized official
• Mariposa Community Health Center, Inc

  • Federally Qualified Health Center (FQHC)
  • Rio Rico, AZ
  • NPI 1013213404

  Family Medicine

  NPD (past)
• Mountain View Medical Group, PC

  • Durable Medical Equipment & Medical Supplies
  • Colorado Springs, CO
  • NPI 1144405200
  NPD (past)
• Mountain View Medical Group, PC

  • Family Medicine Physician
  • Colorado Springs, CO
  • NPI 1295787703
  NPD (past)
• Rebecca S Davis-Trujillo MD PC

  • Family Medicine Physician
  • Colorado Springs, CO
  • NPI 1962696864
  NPD (past)

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

{
    "created_epoch": "1153094400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1543363200000",
    "number": "1023035524",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "825 N GRAND AVE STE 100",
            "city": "NOGALES",
            "state": "AZ",
            "postal_code": "856211061",
            "telephone_number": "520-761-2133",
            "fax_number": "520-281-2335"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1852 N MASTICK WAY",
            "city": "NOGALES",
            "state": "AZ",
            "postal_code": "85621",
            "telephone_number": "520-281-1550",
            "fax_number": "520-281-4487"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "1260 S Campbell Rd",
            "address_2": "Building 2",
            "address_purpose": "LOCATION",
            "city": "Green Valley",
            "state": "AZ",
            "postal_code": "856142666",
            "country_code": "US",
            "telephone_number": "520-407-5800",
            "fax_number": "520-407-5990",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "DERICKSON",
        "first_name": "JAMES",
        "middle_name": "LYLE",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-07-17",
        "last_updated": "2018-11-28",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "AZ",
            "license": "37067",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "266946",
            "state": "AZ"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Guadalupe Ibanez Davila, MD
• Nicholas Walker Deer, RN
• Leon Francis Deisering, CRNA
• Dependable Home Health, Inc
• Dependable Medical Equipment, Inc
• Jared Brian Dewitt II
• John Diaz, M.D.
• Biviana A Dicochea, RDH
• Katherine Martina Dols, DDS
• Miriam E Downey, FNP-C

• Family Medicine Physician in Nogales, AZ
• Providers in Nogales, AZ by specialty
• Family Medicine Physician in Arizona

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 28, 2018; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.