Derek R Flake, PT

Primary specialty

Physical TherapistTaxonomy code 225100000X

License

8520PT Issued in AZ

Practice address

4830 Highway 260 Ste 105
Lakeside, AZ 85929-5851

Phone

(928) 532-1221

Fax

(928) 532-1227

NPI assigned

Dec 1, 2009

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 AZ

Enrollment records 1

Medicare enrollment (NPD)

Enrolled

State licenses

Practice roles

Locations

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.

• White Mountain Physical Therapy LTD

  • Physical Therapist
  • Show Low, AZ
  • NPI 1750385654

  AZ, Physical Therapist

  Medicare reassignment Care Compare group NPD
• Ati Holdings of Arizona, LLC

  • Physical Therapist
  • Phoenix, AZ
  • NPI 1871570309
  NPD (past)
• Ideal Rehabilitation LLC

  • Durable Medical Equipment & Medical Supplies
  • Tucson, AZ
  • NPI 1831353614
  NPD (past)

Specialty

Physical Therapist in Private Practice

Education

Other, 2009

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

White Mountain Physical Therapy LTD 15 clinicians

Practice addresses (Care Compare)

Merit-based Incentive Payment System (MIPS)

Final score

30.49 of 100Reported as individual

Quality

20

Improvement activities

0

Cost

74.98

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

{
    "created_epoch": "1259625600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1584316800000",
    "number": "1104154269",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 1420",
            "city": "SHOW LOW",
            "state": "AZ",
            "postal_code": "859021420",
            "telephone_number": "928-532-1221",
            "fax_number": "928-532-1227"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4830 HIGHWAY 260 STE 105",
            "city": "LAKESIDE",
            "state": "AZ",
            "postal_code": "859295851",
            "telephone_number": "928-532-1221",
            "fax_number": "928-532-1227"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "FLAKE",
        "first_name": "DEREK",
        "middle_name": "R",
        "credential": "PT",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2009-12-01",
        "last_updated": "2020-03-16",
        "certification_date": "2020-03-16",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "225100000X",
            "taxonomy_group": "",
            "desc": "Physical Therapist",
            "state": "AZ",
            "license": "8520PT",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "ARIZONA PT LICENSE",
            "identifier": "8520PT",
            "state": "AZ"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Elizabeth Elgin, OTR
• Elk Ridge Surgical Specialists PLLC
• Rachel K Ellsworth, PT
• Eric Healthcare
• Evergreen Hospice and Palliative Care
• Kimberly Fletcher
• Freter Family Practice PLLC
• Frank Freund, CRNA
• Garnet Pain Relief Services, LLC
• Mark Mitchell Garskof, M.D.

• All providers in Lakeside, AZ
• Physical Therapist in Arizona

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 16, 2020; 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.