Derrick Bark, DC, ATC

Primary specialty

ChiropractorTaxonomy code 111N00000X

License

2023000539 Issued in MO

Practice address

344 Woodgreen Dr
Ballwin, MO 63011-5031

Phone

(937) 570-7110

NPI assigned

Nov 1, 2016

Sex

Male

Sole proprietor

Yes

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

Specialties & licenses 2

Addresses

Medicare fee-for-service enrollment

Enrolled in MO

Enrollment records 1

Medicare enrollment (NPD)

Enrolled

Practice roles

Locations

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.

• Carestl Health

  • Federally Qualified Health Center (FQHC)
  • Saint Louis, MO
  • NPI 1376685529

  MO

  Medicare reassignment NPD
• Carestl Health

  • Federally Qualified Health Center (FQHC)
  • Overland, MO
  • NPI 1275363137
  NPD
• Carestl Health

  • Multi-Specialty Clinic/Center
  • Saint Louis, MO
  • NPI 1972596088
  NPD

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

{
    "created_epoch": "1477958400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1673222400000",
    "number": "1194277582",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "344 WOODGREEN DR",
            "city": "BALLWIN",
            "state": "MO",
            "postal_code": "630115031",
            "telephone_number": "937-570-7110"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "344 WOODGREEN DR",
            "city": "BALLWIN",
            "state": "MO",
            "postal_code": "630115031",
            "telephone_number": "937-570-7110"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "BARK",
        "first_name": "DERRICK",
        "name_prefix": "Mr.",
        "credential": "DC, ATC",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2016-11-01",
        "last_updated": "2023-01-09",
        "certification_date": "2022-12-11",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "2255A2300X",
            "taxonomy_group": "",
            "desc": "Specialist/Technologist, Athletic Trainer",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "111N00000X",
            "taxonomy_group": "",
            "desc": "Chiropractor",
            "state": "MO",
            "license": "2023000539",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Ballwin Family Smiles, PLLC
• Ballwin Health Care LLC
• Ballwin Orthopedic Group, LLC
• Alan James Banaszynski, DC
• Marissa Paulette Barbeau, PLPC
• Elaine Barnes, BCBA
• Sharron Jean Bartle, LCSW
• Marilyn Faye Bass, LCSW
• Abbe Lynn Bassin, LCSW
• Ashley Amanda Battaglia, D.C.

• All providers in Ballwin, MO
• Chiropractor in Missouri

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 9, 2023; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.