NPIMap

Individual provider Active NPI

Derrick J Sanderson

  • Urogynecology and Reconstructive Pelvic Surgery (Obstetrics & Gynecology) Physician
  • Winona, MN
National Provider Identifier
1043577448
Registry record updated Nov 8, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Urogynecology and Reconstructive Pelvic Surgery (Obstetrics & Gynecology) PhysicianTaxonomy code 207VF0040X
License
81662 Issued in WI
Practice address
1122 W Highway 61
Winona, MN 55987-1957
Phone
(608) 782-7300
NPI assigned
Apr 23, 2012
Last updated
Nov 8, 2024By the provider in NPPES
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Nov 8, 2024

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

Specialties & licenses 3

Specialty (taxonomy)CodeLicenseStatePrimary
Obstetrics & Gynecology Physician 207V00000X 283330 NY
Urogynecology and Reconstructive Pelvic Surgery (Obstetrics & Gynecology) Physician 207VF0040X 02005887A IN
Urogynecology and Reconstructive Pelvic Surgery (Obstetrics & Gynecology) Physician 207VF0040X 81662 WI Primary

Addresses

Primary practice location

1122 W Highway 61
Winona, MN 55987-1957

Mailing address

1836 South Ave
La Crosse, WI 54601-5429
Phone (608) 782-7300

Other practice location 1

1540 Maple Rd
Williamsville, NY 14221-3647
Phone (716) 568-3600

Other practice location 2

4199 Gateway Blvd Ste 3500
Newburgh, IN 47630-7909
Phone (812) 858-5950

Other identifiers 2

IdentifierTypeStateIssuer
7100666260MedicaidKY
300038901MedicaidIN

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in NY, MN, WI3 enrollments
Eligible to order & refer
  • Part B services
  • Medical equipment
  • Home health
  • Power mobility devices
  • Hospice
Green means eligible to order or refer.

Enrollment records 3

Enrollment IDStateProvider typePAC IDDetails
I20160808002692 NY Practitioner - Obstetrics/Gynecology 6901190313 Reassigns benefits to 1 organization
I20210920000663 MN Practitioner - Obstetrics/Gynecology 6901190313 Reassigns benefits to 1 organization
I20241118002276 WI Practitioner - Obstetrics/Gynecology 6901190313 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Obstetrics/Gynecology
Education
Lake Erie College of Osteopathic Medicine, Erie, 2012
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Telehealth
Offers telehealth services
Group practices
Gundersen Lutheran Medical Center IncGroup PAC ID 2163331414, shared by 16 NPIs, 888 clinicians

Practice addresses (Care Compare)

1122 W Hwy 61
Winona, MN 55987-1957
Phone (507) 615-0600

1836 S Ave
La Crosse, WI 54601-5429
Phone (608) 783-7300

Hospital & facility affiliations

Procedures performed for Medicare patients

ProcedureNumber of procedures
Removal of the uterus1-10

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
02005887AINMDFemale Pelvic Medicine and Reconstructive Surgery (Obstetrics & Gynecology) Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Gundersen Lutheran Medical Center Inc Current Accepting new patients
Kaleida Health CurrentSince Mar 26, 2017 Accepting new patients
Gundersen Lutheran Medical Center Inc CurrentSince Nov 25, 2024 Accepting new patients
Kaleida Health Current Accepting new patients
Gundersen Lutheran Medical Center, Inc CurrentSince Nov 25, 2024 Accepting new patients
Gundersen Lutheran Medical Center Inc CurrentSince Nov 25, 2024 Accepting new patients
Kaleida Health CurrentSince Mar 26, 2017 Accepting new patients
Gundersen Lutheran Medical Center, Inc. Past Accepting new patients

Locations

1122 W Highway 61
Winona, MN 55987
Phone (507) 615-0600

900 Hertel Ave
Buffalo, NY 14216
Phone (716) 871-1571

445 Tremont St
North Tonawanda, NY 14120
Phone (716) 690-2291

1540 Maple Rd
Williamsville, NY 14221
Phone (716) 568-3514

1836 South Ave
La Crosse, WI 54601
Phone (608) 788-8102

1910 South Ave
La Crosse, WI 54601
Phone (608) 775-2287

Interoperability endpoints

  • Direct secure messaging: dsanderson@asap.emadirect.md
  • Direct secure messaging: dsanderson219735@direct.deaconess.com
  • Direct secure messaging: dsanderson920207@direct.emplifyhealth.org

Organizations & group practices 8

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 7

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": "1335139200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1731024000000",
    "number": "1043577448",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1836 SOUTH AVE",
            "city": "LA CROSSE",
            "state": "WI",
            "postal_code": "546015429",
            "telephone_number": "608-782-7300"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1122 W HIGHWAY 61",
            "city": "WINONA",
            "state": "MN",
            "postal_code": "559871957",
            "telephone_number": "608-782-7300"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "1540 Maple Rd",
            "address_purpose": "LOCATION",
            "city": "Williamsville",
            "state": "NY",
            "postal_code": "142213647",
            "country_code": "US",
            "telephone_number": "716-568-3600",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "4199 Gateway Blvd Ste 3500",
            "address_purpose": "LOCATION",
            "city": "Newburgh",
            "state": "IN",
            "postal_code": "476307909",
            "country_code": "US",
            "telephone_number": "812-858-5950",
            "fax_number": "812-858-5955",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "SANDERSON",
        "first_name": "DERRICK",
        "middle_name": "J",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2012-04-23",
        "last_updated": "2024-11-08",
        "certification_date": "2024-11-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207V00000X",
            "taxonomy_group": "",
            "desc": "Obstetrics & Gynecology",
            "state": "NY",
            "license": "283330",
            "primary": false
        },
        {
            "code": "207VF0040X",
            "taxonomy_group": "",
            "desc": "Obstetrics & Gynecology, Urogynecology and Reconstructive Pelvic Surgery",
            "state": "IN",
            "license": "02005887A",
            "primary": false
        },
        {
            "code": "207VF0040X",
            "taxonomy_group": "",
            "desc": "Obstetrics & Gynecology, Urogynecology and Reconstructive Pelvic Surgery",
            "state": "WI",
            "license": "81662",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "7100666260",
            "state": "KY"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "300038901",
            "state": "IN"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Winona, MN

Sources for this page

Verify at the official NPI Registry.