NPIMap

Individual provider Active NPI

Dereck A. Peery, D.O.

  • Orthopaedic Surgery of the Spine Physician
  • Ardmore, OK
National Provider Identifier
1164543203
Registry record updated Jul 23, 2009
On this page

Key facts

NPPES NPI Registry
Primary specialty
Orthopaedic Surgery of the Spine PhysicianTaxonomy code 207XS0117X
License
4546 Issued in OK
Practice address
915 10TH Ave NW
Ardmore, OK 73401-4025
Phone
(580) 223-7200
Fax
(580) 223-7207
NPI assigned
Apr 3, 2007
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jul 23, 2009

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Orthopaedic Surgery of the Spine Physician 207XS0117X 4546 OK Primary

Addresses

Primary practice location

915 10TH Ave NW
Ardmore, OK 73401-4025

Mailing address

915 10TH Ave NW
Ardmore, OK 73401-4025
Phone (580) 223-7200

Other identifiers 3

IdentifierTypeStateIssuer
OK700279OtherOKINDIVIDUAL PTAN
200124470AMedicaidOK
P00442554OtherRAILROAD MEDICARE

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in OK
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
I20070927001030 OK Practitioner - Orthopedic Surgery 3375638844 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Orthopedic Surgery
Education
Kansas City University of Physicians and Surgeons, 2001
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Telehealth
Offers telehealth services
Group practices
Mercy Clinic Oklahoma CommunitiesGroup PAC ID 1153468921, 645 clinicians

Practice addresses (Care Compare)

1011 14TH Ave NW
Ardmore, OK 73401-1828
Phone (580) 220-6132

4300 McAuley Blvd
Oklahoma City, OK 73120-8302
Phone (405) 936-5455

Hospital & facility affiliations

  • Mercy Hospital Ardmore, Inc Hospital, Ardmore, OK, CCN 370047
  • Mercy Hospital Ada Hospital, Ada, OK, CCN 370020
  • Duncan Regional Hospital, Inc Hospital, Duncan, OK, CCN 370023
  • Alliancehealth Durant Hospital, Durant, OK, CCN 370014

Procedures performed for Medicare patients

ProcedureNumber of procedures
Spinal fusion44
Laminectomy or laminotomy (partial removal of spine bones)39

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
4546OKMDPhysical Therapist

Practice roles

OrganizationSpecialtyStatusNew patients
Mercy Clinic Oklahoma Communities CurrentSince Jan 1, 2015 Accepting new patients
Mercy Hospital Ada, Inc Past Accepting new patients
Mercy Hospital Ardmore, Inc. Past Accepting new patients
Mercy Hospital Oklahoma City, Inc Past Accepting new patients
Summit Medical Center Past Accepting new patients
Jackson County Memorial Hospital Authority Past Accepting new patients

Locations

530 N Monte Vista St
Ste A
Ada, OK 74820
Phone (580) 310-9510

915 10th Ave NW
Ardmore, OK 73401
Phone (580) 220-6461

4300 W Memorial Rd
Oklahoma City, OK 73120
Phone (405) 752-3962

4300 McAuley Blvd
Oklahoma City, OK 73120
Phone (405) 936-5455

Interoperability endpoints

  • Direct secure messaging: dpeery145589@directc.mercy.net

Organizations & group practices 6

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 5

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": "1175558400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1248307200000",
    "number": "1164543203",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "915 10TH AVE NW",
            "city": "ARDMORE",
            "state": "OK",
            "postal_code": "734014025",
            "telephone_number": "580-223-7200",
            "fax_number": "580-223-7207"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "915 10TH AVE NW",
            "city": "ARDMORE",
            "state": "OK",
            "postal_code": "734014025",
            "telephone_number": "580-223-7200",
            "fax_number": "580-223-7207"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "PEERY",
        "first_name": "DERECK",
        "middle_name": "A.",
        "name_prefix": "Dr.",
        "credential": "D.O.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2007-04-03",
        "last_updated": "2009-07-23",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207XS0117X",
            "taxonomy_group": "",
            "desc": "Orthopaedic Surgery, Orthopaedic Surgery of the Spine",
            "state": "OK",
            "license": "4546",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "INDIVIDUAL PTAN",
            "identifier": "OK700279",
            "state": "OK"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "200124470A",
            "state": "OK"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "RAILROAD MEDICARE",
            "identifier": "P00442554",
            "state": null
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Ardmore, OK

Sources for this page

Verify at the official NPI Registry.