Angela M Derrick, DPT

Primary specialty

Physical TherapistTaxonomy code 225100000X

License

070018073 Issued in IL

Practice address

800 School St
Carrollton, IL 62016-1436

Phone

(217) 942-6946

NPI assigned

Mar 27, 2006

Sex

Female

Sole proprietor

No

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

Specialties & licenses 2

Addresses

Other names 1

• Miss Angela M Schroeder Former name

Medicare fee-for-service enrollment

Enrolled in IL

Enrollment records 1

Specialty

Physical Therapist in Private Practice

Education

Other, 2001

Medicare assignment

May accept Medicare assignment

Group practices

Booher Health LLC 3 clinicians

Practice addresses (Care Compare)

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.

• Booher Health LLC

  • Physical Therapist
  • Quincy, IL
  • NPI 1215620380

  IL, Physical Therapist

  Medicare reassignment Care Compare group NPD
• Imove Telept, LLC

  • Physical Therapist
  • Chesterfield, MO
  • NPI 1548896442
  NPD

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

{
    "created_epoch": "1143417600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1343779200000",
    "number": "1093775447",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "402 MINARD ST",
            "city": "JERSEYVILLE",
            "state": "IL",
            "postal_code": "620522630",
            "telephone_number": "575-312-4439"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "800 SCHOOL ST",
            "city": "CARROLLTON",
            "state": "IL",
            "postal_code": "620161436",
            "telephone_number": "217-942-6946"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "DERRICK",
        "first_name": "ANGELA",
        "middle_name": "M",
        "name_prefix": "Mrs.",
        "credential": "DPT",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2006-03-27",
        "last_updated": "2012-08-01",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "225100000X",
            "taxonomy_group": "",
            "desc": "Physical Therapist",
            "state": "NM",
            "license": "NM2654",
            "primary": false
        },
        {
            "code": "225100000X",
            "taxonomy_group": "",
            "desc": "Physical Therapist",
            "state": "IL",
            "license": "070018073",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "ANGELA",
            "last_name": "SCHROEDER",
            "middle_name": "M",
            "prefix": "MISS",
            "credential": "MPT",
            "code": "1",
            "type": "Former Name"
        }
    ]
}

• County of Greene
• County of Greene
• Skylar Richard Cox, DMD
• Cypress Therapy and Rehabilitation, LLC
• Dee Anna Darr, MS SLP CCCL
• Georgianna Flowers
• Frye Chiropractic LLC
• Ethan Frye, DC
• Ken Gray, P.T.
• Greene County Ambulance

• All providers in Carrollton, IL
• Physical Therapist in Illinois

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 1, 2012; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.