Scott Alan Deruiter, M.D.

Primary specialty

Family Medicine PhysicianTaxonomy code 207Q00000X

License

43016 Issued in CO

Practice address

109 S Burlington Dr
Pueblo, CO 81007-5560

Phone

(719) 553-2205

Fax

(833) 314-0183

NPI assigned

Apr 6, 2006

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 1

Medicare fee-for-service enrollment

Enrolled in CO

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: Yes
• Power mobility devices: Yes
• Hospice: Yes

Green means eligible to order or refer.

Enrollment records 1

Specialty

Family Practice

Education

Michigan State University College of Human Medicine, 2001

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

Southern Colorado Clinic PCGroup PAC ID 4284524067, 36 clinicians

Practice addresses (Care Compare)

Procedures performed for Medicare patients

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Medicine

Practice roles

Locations

Interoperability endpoints

• Direct secure messaging: scott.deruiter.1@21306.direct.athenahealth.com
• FHIR API: https://api.platform.athenahealth.com/17255/brand/1/csg/1/fhir/r4

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.

• Southern Colorado Clinic PC

  • Clinic/Center
  • Pueblo, CO
  • NPI 1285613554
  Medicare reassignment Care Compare group NPD
• Front Range Family Medicine

  • Family Medicine Physician
  • Colorado Springs, CO
  • NPI 1528275906
  NPD (past)

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

{
    "created_epoch": "1144281600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1711584000000",
    "number": "1093777658",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 9000",
            "city": "PUEBLO",
            "state": "CO",
            "postal_code": "810089000",
            "telephone_number": "719-553-2200",
            "fax_number": "719-553-2216"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "109 S BURLINGTON DR",
            "city": "PUEBLO",
            "state": "CO",
            "postal_code": "810075560",
            "telephone_number": "719-553-2205",
            "fax_number": "833-314-0183"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "DERUITER",
        "first_name": "SCOTT",
        "middle_name": "ALAN",
        "name_prefix": "Dr.",
        "credential": "M.D.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-04-06",
        "last_updated": "2024-03-28",
        "certification_date": "2024-03-28",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "CO",
            "license": "43016",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "59626569",
            "state": "CO"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Kim K Dernovsek, MD
• Derose Children's Dental Clinic, PC
• Michael Anthony Derose
• Katherine R Derossett, NP
• Lucas R Derting, PA-C
• Roberta Martha Desalvo, LPCC
• Desert Bloom Mental Health LLC
• Desert Willow Health and Rehabilitation Center LLC
• Desert Willow Health and Rehabilitation Center LLC (Desert Willow Health and Rehabilitation Center)
• Destiny Incorporated

• Family Medicine Physician in Pueblo, CO
• Providers in Pueblo, CO by specialty
• Family Medicine Physician in Colorado

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 28, 2024; 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.
• 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.