Jack Derovanesian, MD

Primary specialty

Emergency Medicine PhysicianTaxonomy code 207P00000X

License

ME26879 Issued in FL

Practice address

6400 Davis Blvd Ste 103
Naples, FL 34104-5321

Phone

(239) 775-2300

NPI assigned

May 22, 2006

Last updated

May 12, 2008By the provider in NPPES

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 2

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Medicine

State licenses

Practice roles

Networks

• Optimum HealthCare HMO Network
• Freedom Health HMO Network

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.

• Emergency Physicians of Naples PLLC

  • Emergency Medicine Physician
  • Naples, FL
  • NPI 1861410656
  NPD (past)
• Epn Family Care LLC

  • Family Medicine Physician
  • Naples, FL
  • NPI 1013101112
  NPD (past)
• Martin Memorial Medical Center Inc

  dba Cleveland Clinic Martin North, South, Tradition Hospitals

  • Urgent Care Clinic/Center
  • Stuart, FL
  • NPI 1154962918
  NPD (past)
• Sailfish ER SVCS Partnership LLC

  • Emergency Medicine Physician
  • Stuart, FL
  • NPI 1326096645
  NPD (past)

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

{
    "created_epoch": "1148256000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1210550400000",
    "number": "1073567186",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 160448",
            "city": "MIAMI",
            "state": "FL",
            "postal_code": "331160448",
            "telephone_number": "239-262-4519",
            "fax_number": "239-262-5672"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "6400 DAVIS BLVD STE 103",
            "city": "NAPLES",
            "state": "FL",
            "postal_code": "341045321",
            "telephone_number": "239-775-2300"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "DEROVANESIAN",
        "first_name": "JACK",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-05-22",
        "last_updated": "2008-05-12",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207P00000X",
            "taxonomy_group": "",
            "desc": "Emergency Medicine",
            "state": "FL",
            "license": "ME26879",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BC BS FL",
            "identifier": "78470",
            "state": "FL"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "067815500",
            "state": "FL"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Dermatology & Dermasurgery of Naples PA
• Dermatology Clinic of South Florida PA
• Dermatology Group of Florida PA
• Dermatology Specialists of Naples Inc
• Paul David Dernbach, ME
• Jamillia Dervil
• Dery & Eads, P.a.
• Margaret Desear, NP-C
• Designed to Smile PLLC
• Berline Desir

• Emergency Medicine Physician in Naples, FL
• Providers in Naples, FL by specialty
• Emergency Medicine Physician in Florida

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 12, 2008; 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.