NPIMap

Individual provider Active NPI

Derek J. Taylor, PA-C

  • Physician Assistant
  • Mesa, AZ
National Provider Identifier
1093111304
Registry record updated Apr 19, 2018
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physician AssistantTaxonomy code 363A00000X
License
5941 Issued in AZ
Practice address
4320 E. Presidio Street #101
Mesa, AZ 85215-3031
Phone
(480) 706-9430
Fax
(480) 378-2273
NPI assigned
Nov 13, 2014
Last updated
Apr 19, 2018By the provider in NPPES
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Apr 19, 2018

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Physician Assistant 363A00000X 5941 AZ Primary
Surgical Physician Assistant 363AS0400X AZ

Addresses

Primary practice location

4320 E. Presidio Street #101
Mesa, AZ 85215-3031

Mailing address

5155 E. Eagle Drive #20730
Mesa, AZ 85277-3031
Phone (480) 706-9430

Other identifiers 1

IdentifierTypeStateIssuer
983703MedicaidAZ

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20150129000521 AZ Practitioner - Physician Assistant 3476877143 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Physician Assistant
Education
Other, 2014
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Valleywide Surgical Services, LLCGroup PAC ID 0749183259, 5 clinicians

Practice addresses (Care Compare)

4320 E Presidio St
Suite 101
Mesa, AZ 85215-1165
Phone (480) 706-9430

Hospital & facility affiliations

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Physician Assistant

State licenses

LicenseStateTypeSpecialty
5941AZMDPhysician Assistant

Practice roles

OrganizationSpecialtyStatusNew patients
Arizona Spine and Joint Hospital LLC Current Accepting new patients

Interoperability endpoints

  • Direct secure messaging: derektaylor@asjh.medalliesdirect.net

Organizations & group practices 2

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 5

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": "1415836800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1524096000000",
    "number": "1093111304",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "5155 E. EAGLE DRIVE #20730",
            "city": "MESA",
            "state": "AZ",
            "postal_code": "852773031",
            "telephone_number": "480-706-9430",
            "fax_number": "480-378-2273"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4320 E. PRESIDIO STREET #101",
            "city": "MESA",
            "state": "AZ",
            "postal_code": "852153031",
            "telephone_number": "480-706-9430",
            "fax_number": "480-378-2273"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "TAYLOR",
        "first_name": "DEREK",
        "middle_name": "J.",
        "credential": "PA-C",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2014-11-13",
        "last_updated": "2018-04-19",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "AZ",
            "license": "5941",
            "primary": true
        },
        {
            "code": "363AS0400X",
            "taxonomy_group": "",
            "desc": "Physician Assistant, Surgical",
            "state": "AZ",
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "983703",
            "state": "AZ"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Mesa, AZ

Sources for this page

Verify at the official NPI Registry.