Timothy Derrick DO, MD

Primary specialty

Neurological Surgery PhysicianTaxonomy code 207T00000X

License

ME111835 Issued in FL

Practice address

4689 US Highway 17
Suite 11
Orange Park, FL 32003-4831

Phone

(904) 269-7007

Fax

(866) 264-0529

NPI assigned

Nov 9, 2008

Sex

Male

Sole proprietor

No

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

Specialties & licenses 2

Addresses

Other identifiers 1

Electronic endpoints 1

Medicare fee-for-service enrollment

Enrolled in FL

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: Yes
• Power mobility devices: Yes
• Hospice: Yes

Green means eligible to order or refer.

Enrollment records 1

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Medicine

State licenses

Practice roles

Locations

Interoperability endpoints

• Direct secure messaging: timothy.do@hca5.eclinicaldirectplus.com

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.

• Jacksonville Multispecialty Services, LLC

  dba First Coast Orthopedics

  • Orthopaedic Surgery Physician
  • Orange Park, FL
  • NPI 1427298363
  Medicare reassignment NPD

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

{
    "created_epoch": "1226188800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1643241600000",
    "number": "1043464639",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4689 US HIGHWAY 17",
            "address_2": "SUITE 11",
            "city": "ORANGE PARK",
            "state": "FL",
            "postal_code": "320034831",
            "telephone_number": "904-269-7007",
            "fax_number": "866-264-0529"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4689 US HIGHWAY 17",
            "address_2": "SUITE 11",
            "city": "ORANGE PARK",
            "state": "FL",
            "postal_code": "320034831",
            "telephone_number": "904-269-7007",
            "fax_number": "866-264-0529"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "DO",
        "first_name": "TIMOTHY",
        "middle_name": "DERRICK",
        "name_prefix": "Dr.",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2008-11-09",
        "last_updated": "2022-01-27",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207T00000X",
            "taxonomy_group": "",
            "desc": "Neurological Surgery",
            "state": "DC",
            "license": "150583",
            "primary": false
        },
        {
            "code": "207T00000X",
            "taxonomy_group": "",
            "desc": "Neurological Surgery",
            "state": "FL",
            "license": "ME111835",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "009327000",
            "state": "FL"
        }
    ],
    "endpoints": [
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "TIMOTHY.DO@hca5.eclinicaldirectplus.com",
            "affiliation": "N",
            "address_1": "4689 US Highway 17",
            "address_2": "SUITE 11",
            "city": "Orange Park",
            "state": "FL",
            "country_code": "US",
            "postal_code": "320034831",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

• Kyle Distler, DO
• Divinity Home Healthcare, LLC
• Passion Dixon, LMHC
• Dna Comprehensive Therapy Services, LLC
• Dna Comprehensive Therapy Services, LLC (Elite Dna Therapy Services)
• Doc to Door PLLC (Vantagewell)
• Doctors Choice Jacksonville LLC (AccentCare Home Health of Jacksonville)
• Jennifer Carolyn Doherty, PHARMD
• Kristi Doke
• Aaron Dolan, MD

• Neurological Surgery Physician in Orange Park, FL
• Providers in Orange Park, FL by specialty
• Neurological Surgery Physician in Florida

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 27, 2022; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.