Derrick Pratte Olzack, P.A.

Primary specialty

Family Medicine PhysicianTaxonomy code 207Q00000X

License

54432 Issued in CA

Practice address

1775 Third St
Atwater, CA 95301-3608

Phone

(209) 358-5611

Fax

(209) 358-0219

NPI assigned

Jun 7, 2017

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

Medicare fee-for-service enrollment

Enrolled in CA

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

Physician Assistant

Education

Stanford University School of Medicine, 2017

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

Community Health Centers of AmericaGroup PAC ID 3476813460, 112 clinicians

Practice addresses (Care Compare)

Medicare enrollment (NPD)

Enrolled

Credentials

Physician Assistant

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.

• Community Health Centers of America

  • Federally Qualified Health Center (FQHC)
  • Mariposa, CA
  • NPI 1891207684
  Medicare reassignment Care Compare group
• Community Health Centers of America

  • Federally Qualified Health Center (FQHC)
  • Gustine, CA
  • NPI 1245105733
  NPD

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

{
    "created_epoch": "1496793600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1658361600000",
    "number": "1114456738",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1775 3RD ST",
            "city": "ATWATER",
            "state": "CA",
            "postal_code": "953013608",
            "telephone_number": "209-358-5611",
            "fax_number": "209-358-0219"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1775 THIRD ST",
            "city": "ATWATER",
            "state": "CA",
            "postal_code": "953013608",
            "telephone_number": "209-358-5611",
            "fax_number": "209-358-0219"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "OLZACK",
        "first_name": "DERRICK",
        "middle_name": "PRATTE",
        "name_prefix": "Mr.",
        "credential": "P.A.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2017-06-07",
        "last_updated": "2022-07-21",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "CA",
            "license": "54432",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Melina Ochoa
• Yadira Mendoza Olivares
• Morgan Elizabeth Oliver, PT, DPT
• William Gerald Oliver, DDS
• Elisabel Olvera
• Paulina Osuna
• Jaskirth Pamma, DDS
• Robert Parham
• Ashley Parker-Cooper
• Katelynn Parker

• Family Medicine Physician in Atwater, CA
• Providers in Atwater, CA by specialty
• Family Medicine Physician in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 21, 2022; 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.