Individual provider Active NPI

Jamal Jon Derakhshan, MD

  • Diagnostic Radiology Physician
  • Abington, PA
National Provider Identifier
1134410426
Registry record updated Jun 12, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Diagnostic Radiology PhysicianTaxonomy code 2085R0202X
License
MD449544 Issued in PA
Practice address
1200 Old York Rd
Abington, PA 19001-3720
Phone
(215) 964-5775
NPI assigned
Apr 21, 2011
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jun 12, 2024

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Diagnostic Radiology Physician 2085R0202X 2018011780 MO
Diagnostic Radiology Physician 2085R0202X MD449544 PA Primary

Addresses

Primary practice location

1200 Old York Rd
Abington, PA 19001-3720

Mailing address

1200 Old York Rd
Abington, PA 19001-3720

Other identifiers 1

IdentifierTypeStateIssuer
200053550MedicaidMO

Electronic endpoints 1

TypeEndpointUseAffiliation
FHIR URL https://epicproxy.et0965.epichosted.com/FHIRProxy/api/FHIR/DSTU2/ Washington University

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in PA, MO, NJ3 enrollments
Eligible to order & refer
  • Part B services: Yes
  • Medical equipment: Yes
  • Home health: Yes
  • Power mobility devices: Yes
  • Hospice: Yes
Green means eligible to order or refer.

Enrollment records 3

Enrollment IDStateProvider typePAC IDDetails
I20170607001262 PA Practitioner - Diagnostic Radiology 6709182751 Reassigns benefits to 3 organizations
I20180515001062 MO Practitioner - Diagnostic Radiology 6709182751 Reassigns benefits to 2 organizations
I20240529000363 NJ Practitioner - Diagnostic Radiology 6709182751 Reassigns benefits to 2 organizations

Care Compare profile

Medicare Care Compare
Specialty
Diagnostic Radiology
Education
Other, 2011
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Clinical Health Care Associates of New Jersey PCGroup PAC ID 0749180198, shared by 7 NPIs, 793 clinicians
University of Penn-Medical GroupGroup PAC ID 6204730955, 3,433 clinicians

Practice addresses (Care Compare)

1006 Mantua Pike
Woodbury, NJ 08097-1221
Phone (856) 686-8282

1865 Route 70 E 130
Rad Cherry Hill
Cherry Hill, NJ 08003-2013
Phone (856) 433-2535

3400 Spruce St
Philadelphia, PA 19104-4238
Phone (215) 662-3000

Hospital & facility affiliations

  • Hospital of Univ of Pennsylvania Hospital, Philadelphia, PA, CCN 390111
  • Pennsylvania Hospital Hospital, Philadelphia, PA, CCN 390226
  • Penn Presbyterian Medical Center Hospital, Philadelphia, PA, CCN 390223
  • Chester County Hospital Hospital, West Chester, PA, CCN 390179
  • Doylestown Hospital Hospital, Doylestown, PA, CCN 390203

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
MD449544PAMDDiagnostic Radiology Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Methodist Associates in Healthcare, Inc. CurrentSince May 25, 2024 Accepting new patients
University of Penn-Medical Group Diagnostic Radiology CurrentSince Jul 1, 2017 Accepting new patients
Clinical Health Care Associates of New Jersey PC CurrentSince Jul 1, 2024 Accepting new patients
Methodist Associates in Healthcare, Inc CurrentSince May 25, 2024 Accepting new patients
Clinical Health Care Associates of New Jersey, PC Current Accepting new patients
Clinical Health Care Associates of New Jersey, P.C. Diagnostic Radiology CurrentSince Jul 1, 2024 Accepting new patients
Montgomery County Advanced Medical Imaging, LLC CurrentSince Jul 1, 2022 Accepting new patients
University of Penn-Medical Group Current Accepting new patients
Miracl, LLC CurrentSince Dec 24, 2018 Accepting new patients
Clinical Health Care Associates of New Jersey, PC CurrentSince Jul 1, 2024 Accepting new patients
Washington University Diagnostic Radiology CurrentSince Jul 1, 2018 Accepting new patients
Methodist Associates in Healthcare, Inc Diagnostic Radiology Current Accepting new patients
Radiology Group of Abington PC Diagnostic Radiology CurrentSince May 1, 2022 Accepting new patients
University of Penn-Medical Group CurrentSince Jul 1, 2017 Accepting new patients

Locations

1000 W 10th St
Rolla, MO 65401
Phone (573) 364-9000

660 S Euclid Ave
#8131
Saint Louis, MO 63110
Phone (314) 362-2809

510 S Kingshighway Blvd
Saint Louis, MO 63110
Phone (314) 362-0177

510 S Kingshighway Blvd
#8131
Saint Louis, MO 63110
Phone (314) 362-2900

1865 Route 70 E
Ste 130
Cherry Hill, NJ 08003
Phone (856) 433-2535

3205 Fire Rd
Egg Hbr Twp, NJ 08234
Phone (609) 407-1113

1006 Mantua Pike
Woodbury Hts, NJ 08097
Phone (856) 845-6880

1200 York Rd
Abington, PA 19001
Phone (215) 481-2222

3624 Market St
Fl 2
Philadelphia, PA 19104
Phone (215) 615-3669

2301 S Broad St
Ste 102
Philadelphia, PA 19148
Phone (215) 952-5175

2701 Blair Mill Rd
Ste 9
Willow Grove, PA 19090
Phone (215) 481-3377

Organizations & group practices 14

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.

View all 14

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": "1303344000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1718150400000",
    "number": "1134410426",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1200 OLD YORK RD",
            "city": "ABINGTON",
            "state": "PA",
            "postal_code": "190013720"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1200 OLD YORK RD",
            "city": "ABINGTON",
            "state": "PA",
            "postal_code": "190013720",
            "telephone_number": "215-964-5775"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "DERAKHSHAN",
        "first_name": "JAMAL",
        "middle_name": "JON",
        "name_prefix": "Dr.",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2011-04-21",
        "last_updated": "2024-06-12",
        "certification_date": "2024-06-12",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "2085R0202X",
            "taxonomy_group": "",
            "desc": "Radiology, Diagnostic Radiology",
            "state": "MO",
            "license": "2018011780",
            "primary": false
        },
        {
            "code": "2085R0202X",
            "taxonomy_group": "",
            "desc": "Radiology, Diagnostic Radiology",
            "state": "PA",
            "license": "MD449544",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "200053550",
            "state": "MO"
        }
    ],
    "endpoints": [
        {
            "endpointType": "FHIR",
            "endpointTypeDescription": "FHIR URL",
            "endpoint": "https://epicproxy.et0965.epichosted.com/FHIRProxy/api/FHIR/DSTU2/",
            "affiliation": "Y",
            "affiliationName": "Washington University",
            "address_1": "510 S Kingshighway Blvd",
            "address_2": "Dept Radiology",
            "city": "Saint Louis",
            "state": "MO",
            "country_code": "US",
            "postal_code": "631101016",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

Other providers in Abington, PA

Sources for this page

Verify at the official NPI Registry.