Derrek Giansiracusa

Primary specialty

Dermatology PhysicianTaxonomy code 207N00000X

License

011498 Issued in AZ

Practice address

11851 N 51St Ave Ste E130
Glendale, AZ 85304-2843

Phone

(623) 299-9540

NPI assigned

Mar 20, 2023

Sex

Male

Sole proprietor

Yes

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 AZ

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 1

Specialty

Dermatology

Education

Lake Erie College of Osteopathic Medicine, Bradenton, 2023

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

Omni Dermatology IncorporatedGroup PAC ID 5698846558, 13 clinicians

Practice addresses (Care Compare)

Procedures performed for Medicare patients

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Osteopathy

Practice roles

Locations

Interoperability endpoints

• FHIR API: https://api.platform.athenahealth.com/6619/brand/1/csg/1/fhir/r4

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.

• Omni Dermatology Incorporated

  • Dermatology Physician
  • Glendale, AZ
  • NPI 1003082090

  Single Specialty

  Medicare reassignment Care Compare group NPD

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

{
    "created_epoch": "1679270400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1742860800000",
    "number": "1154023737",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "11851 N 51ST AVE STE E130",
            "city": "GLENDALE",
            "state": "AZ",
            "postal_code": "853042843"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "11851 N 51ST AVE STE E130",
            "city": "GLENDALE",
            "state": "AZ",
            "postal_code": "853042843",
            "telephone_number": "623-299-9540"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "GIANSIRACUSA",
        "first_name": "DERREK",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2023-03-20",
        "last_updated": "2025-03-25",
        "certification_date": "2025-03-25",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207N00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Dermatology",
            "state": "AZ",
            "license": "011498",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Lauren Gheorghe
• Sara R Ghobraiel, MD
• Ora Gholson
• Nilofar Ghulam Hazrat, PHARM.D
• Kathleen Giacini, MAED
• Giardina Sportsmedicine Consultants, Inc.
• Casey Robert Giblin
• Gibson Behavioral Health LLC
• Heather Gibson, DPT
• Jackson Thomas Gibson

• Dermatology Physician in Glendale, AZ
• Providers in Glendale, AZ by specialty
• Dermatology Physician in Arizona

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 25, 2025; 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.