NPIMap

Individual provider Active NPI

Jerome D. Derdel, MD

  • Therapeutic Radiology Physician
  • State College, PA
National Provider Identifier
1104812601
Registry record updated Jun 21, 2023
On this page

Key facts

NPPES NPI Registry
Primary specialty
Therapeutic Radiology PhysicianTaxonomy code 2085R0203X
License
MD038685L Issued in PA
Practice address
1800 E Park Ave
State College, PA 16803-6709
Phone
(814) 234-6726
Fax
(814) 234-1553
NPI assigned
Sep 21, 2005
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jun 21, 2023

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Radiation Oncology Physician 2085R0001X MD038685L PA
Therapeutic Radiology Physician 2085R0203X MD038685L PA Primary

Addresses

Primary practice location

1800 E Park Ave
State College, PA 16803-6709

Mailing address

100 N Academy Ave
Danville, PA 17822-4903
Phone (570) 271-6144

Other identifiers 1

IdentifierTypeStateIssuer
1104812601OtherNPI

Electronic endpoints 1

TypeEndpointUseAffiliation
Direct Messaging Address jderdel75100@direct.geisinger.edu Direct

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in PA
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
I20101210000456 PA Practitioner - Radiation Oncology 5294922662 Reassigns benefits to 4 organizations

Care Compare profile

Medicare Care Compare
Specialty
Radiation Oncology
Education
Other, 1978
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Mount Nittany Medical Center Health Services IncGroup PAC ID 8426136797, 366 clinicians
Geisinger ClinicGroup PAC ID 5395657001, 3,432 clinicians

Practice addresses (Care Compare)

129 Medical Park LN
Bellefonte, PA 16823-9112
Phone (814) 355-3626

141 Medical Park LN
Bellefonte, PA 16823-9112
Phone (814) 355-7322

143 Hospital Dr
State College, PA 16803-5500
Phone (814) 237-3470

155 Wellness Way
State College, PA 16803-6702

155 Wellness Way
State College, PA 16803-6797
Phone (814) 231-7000

400 Highland Ave
Lewistown, PA 17044-1167
Phone (717) 248-5411

Hospital & facility affiliations

  • Mount Nittany Medical Center Hospital, State College, PA, CCN 390268
  • Geisinger-Lewistown Hospital Hospital, Lewistown, PA, CCN 390048
  • Geisinger Medical Center Hospital, Danville, PA, CCN 390006

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Doctor of Medicine

State licenses

LicenseStateTypeSpecialty
MD038685LPAMDRadiation Oncology Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Geisinger Clinic Current Accepting new patients
Mount Nittany Medical Center Health Services Inc CurrentSince Aug 1, 2015 Accepting new patients
The Milton S Hershey Medical Center Physicians Group Radiation Oncology CurrentSince Nov 1, 2018 Accepting new patients
Pinnacle Health Medical Services CurrentSince Oct 21, 2019 Accepting new patients
Pinnacle Health Medical Services CurrentSince Oct 21, 2019 Accepting new patients
Pinnacle Health Medical Services Current Accepting new patients
The Milton S Hershey Medical Center Physician Group Therapeutic Radiology CurrentSince Nov 1, 2018 Accepting new patients
Geisinger Clinic CurrentSince Aug 27, 2020 Accepting new patients
Wellspan Medical Group Current Accepting new patients
The Milton S Hershey Medical Center Physicians Group Current Accepting new patients
Mount Nittany Medical Center Health Services Inc Past Accepting new patients
Geisinger Clinic Past Accepting new patients

Locations

141 Medical Park Ln
Bellefonte, PA 16823
Phone (814) 355-7322

100 N Academy Ave
Danville, PA 17822

2501 N 3rd St
Fl 2
Harrisburg, PA 17110
Phone (717) 782-2100

500 University Dr
#A4
Hershey, PA 17033
Phone (717) 531-6261

500 University Dr
#A410
Hershey, PA 17033
Phone (717) 531-8131

400 Highland Ave
Lewistown, PA 17044
Phone (717) 242-7473

2494 Bernville Rd
Ste 106
Reading, PA 19605
Phone (610) 898-1800

703 Martin F Gibbons Blvd
Scranton, PA 18519
Phone (570) 846-2340

155 Wellness Way
State College, PA 16803
Phone (800) 367-0179

1850 E Park Ave
Ste 201
State College, PA 16803
Phone (814) 234-8800

25 Monument Rd
Ste 270
York, PA 17403
Phone (717) 741-8250

Interoperability endpoints

  • Direct secure messaging: jderdel220304@wellspan.direct-ci.com

Organizations & group practices 12

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.

Hospital & facility affiliations 40

Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.

View all 40

NPI Registry JSON

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

{
    "created_epoch": "1127260800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1687305600000",
    "number": "1104812601",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "100 N ACADEMY AVE",
            "city": "DANVILLE",
            "state": "PA",
            "postal_code": "178224903",
            "telephone_number": "570-271-6144",
            "fax_number": "570-271-6578"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1800 E PARK AVE",
            "city": "STATE COLLEGE",
            "state": "PA",
            "postal_code": "168036709",
            "telephone_number": "814-234-6726",
            "fax_number": "814-234-1553"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "DERDEL",
        "first_name": "JEROME",
        "middle_name": "D.",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2005-09-21",
        "last_updated": "2023-06-21",
        "certification_date": "2023-06-21",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "2085R0001X",
            "taxonomy_group": "",
            "desc": "Radiology, Radiation Oncology",
            "state": "PA",
            "license": "MD038685L",
            "primary": false
        },
        {
            "code": "2085R0203X",
            "taxonomy_group": "",
            "desc": "Radiology, Therapeutic Radiology",
            "state": "PA",
            "license": "MD038685L",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "NPI",
            "identifier": "1104812601",
            "state": null
        }
    ],
    "endpoints": [
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "jderdel75100@direct.geisinger.edu",
            "affiliation": "N",
            "use": "DIRECT",
            "useDescription": "Direct",
            "address_1": "1800 E Park Ave",
            "city": "State College",
            "state": "PA",
            "country_code": "US",
            "postal_code": "168036709",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

Other providers in State College, PA

Sources for this page

Verify at the official NPI Registry.