NPIMap

Individual provider Active NPI

Derek Douglas Magnuson, PA-C

  • Medical Physician Assistant
  • Tampa, FL
National Provider Identifier
1124115126
Registry record updated Jan 22, 2021
On this page

Key facts

NPPES NPI Registry
Primary specialty
Medical Physician AssistantTaxonomy code 363AM0700X
License
PA9101889 Issued in FL
Practice address
7550 N Dale Mabry Hwy
Tampa, FL 33614-3226
Phone
(813) 885-4706
Fax
(813) 885-9463
NPI assigned
Oct 10, 2006
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jan 22, 2021

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Physician Assistant 363A00000X PA9101889 FL
Medical Physician Assistant 363AM0700X PA9101889 FL Primary

Addresses

Primary practice location

7550 N Dale Mabry Hwy
Tampa, FL 33614-3226

Mailing address

7550 N Dale Mabry Hwy
Tampa, FL 33614-3226
Phone (813) 885-4706

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in FL
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
I20050607000396 FL Practitioner - Physician Assistant 4082657473 Reassigns benefits to 2 organizations

Care Compare profile

Medicare Care Compare
Specialty
Physician Assistant
Education
Other, 2001
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Telehealth
Offers telehealth services
Group practices
Adventhealth Primary Care Network IncGroup PAC ID 1557722410, 428 clinicians

Practice addresses (Care Compare)

661 E Altamonte Dr
Suite 115
Altamonte Springs, FL 32701-5102
Phone (407) 831-4040

7550 N Dale Mabry Hwy
Tampa, FL 33614-3226
Phone (813) 885-4706

Hospital & facility affiliations

  • Adventhealth Home Health Home health agency, Temple Terrace, FL, CCN 107414
  • Adventhealth Tampa Hospital, Tampa, FL, CCN 100173
  • AdventHealth Carrollwood Hospital, Tampa, FL, CCN 100069
  • St Josephs Hospital Hospital, Tampa, FL, CCN 100075

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Physician Assistant

Interoperability endpoints

  • Direct secure messaging: dmagnuson73425@adventhealth.direct-ci.com

Organizations & group practices 2

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 6

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

NPI Registry JSON

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

{
    "created_epoch": "1160438400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1611273600000",
    "number": "1124115126",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "7550 N DALE MABRY HWY",
            "city": "TAMPA",
            "state": "FL",
            "postal_code": "336143226",
            "telephone_number": "813-885-4706",
            "fax_number": "813-885-9463"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "7550 N DALE MABRY HWY",
            "city": "TAMPA",
            "state": "FL",
            "postal_code": "336143226",
            "telephone_number": "813-885-4706",
            "fax_number": "813-885-9463"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "MAGNUSON",
        "first_name": "DEREK",
        "middle_name": "DOUGLAS",
        "credential": "PA-C",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-10-10",
        "last_updated": "2021-01-22",
        "certification_date": "2021-01-22",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "FL",
            "license": "PA9101889",
            "primary": false
        },
        {
            "code": "363AM0700X",
            "taxonomy_group": "",
            "desc": "Physician Assistant, Medical",
            "state": "FL",
            "license": "PA9101889",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Tampa, FL

Sources for this page

Verify at the official NPI Registry.