Individual provider Active NPI

Matthew Thomas Derry, D.C.

  • Chiropractor
  • Parker, CO
National Provider Identifier
1124294921
Registry record updated May 14, 2008
On this page

Key facts

NPPES NPI Registry
Primary specialty
ChiropractorTaxonomy code 111N00000X
License
CHR-6229 Issued in CO
Practice address
12919 Stroh Ranch CT
Unit B
Parker, CO 80134-7707
Phone
(720) 851-2475
Fax
(720) 851-2476
NPI assigned
May 1, 2008
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on May 14, 2008

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Chiropractor 111N00000X CHR-6229 CO Primary

Addresses

Primary practice location

12919 Stroh Ranch CT
Unit B
Parker, CO 80134-7707

Mailing address

12919 Stroh Ranch CT
Unit B
Parker, CO 80134-7707
Phone (720) 851-2475

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in CO

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20080731000078 CO Practitioner - Chiropractic 8820162456 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Chiropractic
Education
Other, 2008
Medicare assignment
May accept Medicare assignment

Practice addresses (Care Compare)

18551 E Mainstreet
Suite 1D
Parker, CO 80134-4951
Phone (720) 851-7400

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
CHR-6229COMDChiropractor

Practice roles

OrganizationSpecialtyStatusNew patients
Back to Wellness Chiropractor CurrentSince May 10, 2008 Accepting new patients

Locations

12919 Stroh Ranch Ct
Unit B
Parker, CO 80134
Phone (720) 851-2475

18551 E Mainstreet
Ste 1D
Parker, CO 80134
Phone (720) 851-2475

Organizations & group practices 1

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.

NPI Registry JSON

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

{
    "created_epoch": "1209600000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1210723200000",
    "number": "1124294921",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "12919 STROH RANCH CT",
            "address_2": "UNIT B",
            "city": "PARKER",
            "state": "CO",
            "postal_code": "801347707",
            "telephone_number": "720-851-2475",
            "fax_number": "720-851-2476"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "12919 STROH RANCH CT",
            "address_2": "UNIT B",
            "city": "PARKER",
            "state": "CO",
            "postal_code": "801347707",
            "telephone_number": "720-851-2475",
            "fax_number": "720-851-2476"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "DERRY",
        "first_name": "MATTHEW",
        "middle_name": "THOMAS",
        "name_prefix": "Dr.",
        "credential": "D.C.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2008-05-01",
        "last_updated": "2008-05-14",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "111N00000X",
            "taxonomy_group": "",
            "desc": "Chiropractor",
            "state": "CO",
            "license": "CHR-6229",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Parker, CO

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 14, 2008; 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.