Brian R Derrick, D.M.D

Primary specialty

General Practice DentistryTaxonomy code 1223G0001X

License

SC3949 Issued in SC

Practice address

104 N Main St
Greenville, SC 29601-2721

Phone

(864) 243-8371

Fax

(864) 243-8374

NPI assigned

Jan 23, 2007

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

Medicare fee-for-service enrollment

Enrolled in SC

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: Yes
• Power mobility devices: No
• Hospice: Yes

Green means eligible to order or refer.

Enrollment records 1

Medicare enrollment (NPD)

Enrolled

State licenses

Practice roles

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.

• Falls Park Dentistry

  • General Practice Dentistry
  • Greenville, SC
  • NPI 1790950202
  NPD (past) Authorized official

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

{
    "created_epoch": "1169510400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1211500800000",
    "number": "1063566396",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "104 N MAIN ST",
            "city": "GREENVILLE",
            "state": "SC",
            "postal_code": "296012721",
            "telephone_number": "864-243-8371",
            "fax_number": "864-243-8374"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "104 N MAIN ST",
            "city": "GREENVILLE",
            "state": "SC",
            "postal_code": "296012721",
            "telephone_number": "864-243-8371",
            "fax_number": "864-243-8374"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "DERRICK",
        "first_name": "BRIAN",
        "middle_name": "R",
        "name_prefix": "Dr.",
        "credential": "D.M.D",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2007-01-23",
        "last_updated": "2008-05-23",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1223G0001X",
            "taxonomy_group": "",
            "desc": "Dentist, General Practice",
            "state": "SC",
            "license": "SC3949",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Quade'Ja Derello
• Dermatology Specialists LLC
• Sarah Ashley Derocha, APN
• Joseph W Derosa
• Gerlanda Derr, APRN
• Taylor Derums, PA-C
• Geera Desai, M.D.
• Nayan Desai, M.D.
• Rachna M Desai, CRNA
• Reena A Desai, MD

• General Practice Dentistry in Greenville, SC
• Providers in Greenville, SC by specialty
• General Practice Dentistry in South Carolina

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 23, 2008; 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.