NPIMap

Individual provider Active NPI

David T Deroos, DO

  • Family Medicine Physician
  • Johnson City, TN
National Provider Identifier
1043773658
Registry record updated Jul 3, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Medicine PhysicianTaxonomy code 207Q00000X
License
4949 Issued in TN
Practice address
205 Summer Rose LN
Johnson City, TN 37601-5356
Phone
(704) 658-8727
NPI assigned
Apr 10, 2019
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jul 3, 2024

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 4949 TN Primary

Addresses

Primary practice location

205 Summer Rose LN
Johnson City, TN 37601-5356

Mailing address

205 Summer Rose LN
Johnson City, TN 37601-5356

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in TN, NC2 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 2

Enrollment IDStateProvider typePAC IDDetails
I20221107002589 TN Practitioner - Family Practice 2860726361 Reassigns benefits to 1 organization
I20241210003705 NC Practitioner - Family Practice 2860726361 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Family Practice
Education
Edward Via Col of Osteo Medicine-Carolinas Campus, 2019
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Telehealth
Offers telehealth services
Group practices

Practice addresses (Care Compare)

351 Wellesley Trade LN
Suite 100
Cary, NC 27519-5669
Phone (919) 576-8100

Hospital & facility affiliations

Procedures performed for Medicare patients

ProcedureNumber of procedures
Removal of skin lesions1-10

National Provider Directory

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

Practice roles

OrganizationSpecialtyStatusNew patients
Duke University Affiliated Physicians, Inc. Family Medicine CurrentSince Jan 6, 2024 Accepting new patients
State of Franklin Healthcare Associates PLLC Family Medicine CurrentSince Jul 1, 2024 Accepting new patients
State of Franklin Healthcare Associates PLLC CurrentSince Apr 28, 2024 Accepting new patients
Duke University Affiliated Physicians, Inc. Family Medicine Current Accepting new patients
Duke University Affiliated Physicians, Inc. Family Medicine CurrentSince Jan 6, 2024 Accepting new patients
Duke Health Integrated Practice, Inc. Past Accepting new patients
Wellmont Medical Associates, Inc. PastSince Sep 1, 2022 Accepting new patients
Major Hospital Past Accepting new patients

Locations

351 Wellesley Trade Ln
Ste 100
Cary, NC 27519
Phone (919) 576-8100

100 Duke Health Cary Pl
Ste 230
Cary, NC 27519
Phone (919) 385-4400

7200 Creedmoor Rd
Ste 208
Raleigh, NC 27613
Phone (919) 327-1650

215 E Watauga Ave
Johnson City, TN 37601
Phone (423) 433-6200

313 Princeton Rd
Ste 3
Johnson City, TN 37601
Phone (423) 282-4819

Interoperability endpoints

  • Direct secure messaging: dderoos610294@direct.medicine.duke.edu
  • FHIR API: https://api.platform.athenahealth.com/24871/brand/1/csg/1/fhir/r4

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 and National Provider Directory roles.

Hospital & facility affiliations 6

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": "1554854400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1719964800000",
    "number": "1043773658",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "205 SUMMER ROSE LN",
            "city": "JOHNSON CITY",
            "state": "TN",
            "postal_code": "376015356"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "205 SUMMER ROSE LN",
            "city": "JOHNSON CITY",
            "state": "TN",
            "postal_code": "376015356",
            "telephone_number": "704-658-8727"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "DEROOS",
        "first_name": "DAVID",
        "middle_name": "T",
        "credential": "DO",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2019-04-10",
        "last_updated": "2024-07-03",
        "certification_date": "2024-07-03",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "TN",
            "license": "4949",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Johnson City, TN

Sources for this page

Verify at the official NPI Registry.