NPIMap

Organization Active NPI

Derick Dermatology, PLLC

  • Dermatology Physician
  • Crystal Lake, IL
National Provider Identifier
1134664402
Registry record updated Sep 9, 2022
On this page

Key facts

NPPES NPI Registry
Primary specialty
Dermatology PhysicianTaxonomy code 207N00000X
License
36112935 Issued in IL
Legal business name
DERICK DERMATOLOGY, PLLC
Practice address
525 E Congress Parkway
Suite 200
Crystal Lake, IL 60014
Phone
(847) 381-8899
Fax
(847) 381-8999
NPI assigned
Dec 22, 2016
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Sep 9, 2022

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

Authorized official

Name
Amy Derick, M.D.NPI 1245279884
Title
Medical Director
Phone
(847) 381-8899

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Dermatology PhysicianGroup: 193400000X SINGLE SPECIALTY GROUP 207N00000X 36112935 IL Primary
Non-Pharmacy Dispensing Site 332900000X

Addresses

Primary practice location

525 E Congress Parkway
Suite 200
Crystal Lake, IL 60014

Mailing address

PO Box 6685
Carol Stream, IL 60197-6685
Phone (847) 381-8899

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20060922000130 IL Part B Supplier - Clinic/Group Practice 1557366796 Receives reassigned benefits from 60 practitioners
18 other NPIs on this enrollment
Practice locations: Plainfield, IL; Arlington Heights, IL; Skokie, IL; Orland Park, IL; Oak Park, IL; Oak Brook, IL; Northbrook, IL; Naperville, IL…

Other NPIs with the same Medicare PAC ID 1

NPIs whose Medicare enrollments share a PECOS associate control ID (the same enrolled entity).

Other NPIs on the same Medicare enrollment 18

NPIs listed together on one Medicare enrollment, typically parts of the same organization.

View all 18

Laboratory certificates & supplier records

Derived by NPIMap

These CMS records do not include an NPI. They are shown because their name and street address match this provider’s.

CLIA laboratory certificates

CLIA numberLaboratoryCertificateExpires
14D2115509Derick Dermatology LLC525 E Congress Pkwy, Ste 200, Crystal Lake, IL 60014Certificate of waiverAug 1, 2026

National Provider Directory

National Provider Directory

Practitioners & affiliated clinicians

Practitioners 62

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

View all 62

NPI Registry JSON

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

{
    "created_epoch": "1482364800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1662681600000",
    "number": "1134664402",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 6685",
            "city": "CAROL STREAM",
            "state": "IL",
            "postal_code": "601976685",
            "telephone_number": "847-381-8899",
            "fax_number": "547-381-8999"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "525 E CONGRESS PARKWAY",
            "address_2": "SUITE 200",
            "city": "CRYSTAL LAKE",
            "state": "IL",
            "postal_code": "60014",
            "telephone_number": "847-381-8899",
            "fax_number": "847-381-8999"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "DERICK DERMATOLOGY, PLLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2016-12-22",
        "last_updated": "2022-09-09",
        "certification_date": "2022-09-09",
        "status": "A",
        "authorized_official_last_name": "DERICK",
        "authorized_official_first_name": "AMY",
        "authorized_official_title_or_position": "MEDICAL DIRECTOR",
        "authorized_official_telephone_number": "847-381-8899",
        "authorized_official_credential": "M.D."
    },
    "taxonomies": [
        {
            "code": "207N00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Dermatology",
            "state": "IL",
            "license": "36112935",
            "primary": true
        },
        {
            "code": "332900000X",
            "taxonomy_group": "",
            "desc": "Non-Pharmacy Dispensing Site",
            "state": null,
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Crystal Lake, IL

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 9, 2022; 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.