Susan Kay Derrickson, NP-BC

Primary specialty

Nurse PractitionerTaxonomy code 363L00000X

License

71014637A Issued in IN

Practice address

213 Middlebury St
Goshen, IN 46528-2956

Phone

(574) 534-3300

NPI assigned

Nov 20, 2023

Sex

Female

Sole proprietor

No

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

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Enrolled in IN

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: Yes
• Power mobility devices: Yes
• Hospice: No

Green means eligible to order or refer.

Enrollment records 1

Specialty

Nurse Practitioner

Education

Other, 2021

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

Maple City Health Care Center IncGroup PAC ID 2163569401, 29 clinicians

Nephrology Physicians, LLCGroup PAC ID 1850289273, 11 clinicians

Practice addresses (Care Compare)

Medicare enrollment (NPD)

Enrolled

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.

• Maple City Health Care Center, Inc.

  • Federally Qualified Health Center (FQHC)
  • Goshen, IN
  • NPI 1033166095
  Medicare reassignment Care Compare group NPD
• Nephrology Physicians LLC

  • Nephrology Physician
  • Mishawaka, IN
  • NPI 1518996719
  Medicare reassignment Care Compare group
• Maple City Health Care Center, Inc

  dba Westend Community Health Center

  • Federally Qualified Health Center (FQHC)
  • Goshen, IN
  • NPI 1275220303
  NPD

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

{
    "created_epoch": "1700438400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1788912000000",
    "number": "1104691153",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "710 PARK PL FL 2",
            "city": "MISHAWAKA",
            "state": "IN",
            "postal_code": "465453519",
            "telephone_number": "574-273-6767",
            "fax_number": "574-273-6757"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "213 MIDDLEBURY ST",
            "city": "GOSHEN",
            "state": "IN",
            "postal_code": "465282956",
            "telephone_number": "574-534-3300"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "820 Waterbury Park Dr",
            "address_purpose": "LOCATION",
            "city": "Elkhart",
            "state": "IN",
            "postal_code": "465172358",
            "country_code": "US",
            "telephone_number": "574-273-6767",
            "fax_number": "574-273-6757",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "2606 Peddlers Village Rd Ste 210",
            "address_purpose": "LOCATION",
            "city": "Goshen",
            "state": "IN",
            "postal_code": "465261004",
            "country_code": "US",
            "telephone_number": "574-534-3300",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "2855 Miller Dr Ste 209",
            "address_purpose": "LOCATION",
            "city": "Plymouth",
            "state": "IN",
            "postal_code": "465638096",
            "country_code": "US",
            "telephone_number": "574-273-6767",
            "fax_number": "574-273-6757",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "808 N 3rd St",
            "address_purpose": "LOCATION",
            "city": "Goshen",
            "state": "IN",
            "postal_code": "465287100",
            "country_code": "US",
            "telephone_number": "574-534-0088",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "2257 Karisa Dr",
            "address_purpose": "LOCATION",
            "city": "Goshen",
            "state": "IN",
            "postal_code": "465266942",
            "country_code": "US",
            "telephone_number": "574-273-6767",
            "fax_number": "574-273-6757",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "710 Park Pl",
            "address_purpose": "LOCATION",
            "city": "Mishawaka",
            "state": "IN",
            "postal_code": "465453519",
            "country_code": "US",
            "telephone_number": "574-273-6767",
            "fax_number": "574-273-6757",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "DERRICKSON",
        "first_name": "SUSAN",
        "middle_name": "KAY",
        "credential": "NP-BC",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2023-11-20",
        "last_updated": "2026-09-09",
        "certification_date": "2026-09-09",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363L00000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner",
            "state": "IN",
            "license": "71014637A",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Victoria Delgado
• Peter M Delneky, MD
• Michael Glen Delucenay
• Dental Center of Goshen PLLC
• Michael S. Deranek, MSW, LSW, CSAYP
• Carol A Derucki, LMHC
• Sarah Detro
• Aaron Blaine Detwiler, MSW, LCSW
• Jamie Marie Detwiler, FNP-BC
• John Hanlan Deuschle, D.D.S.

• Nurse Practitioner in Goshen, IN
• Providers in Goshen, IN by specialty
• Nurse Practitioner in Indiana

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 9, 2026; 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.