Carissa Dersam

Primary specialty

Case Manager/Care CoordinatorTaxonomy code 171M00000X

Practice address

1550 Sheridan Dr Ste 302
Lancaster, OH 43130-1380

Phone

(740) 901-3040

NPI assigned

Feb 2, 2024

Last updated

Apr 25, 2024By the provider in NPPES

Sex

Female

Sole proprietor

Yes

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

Specialties & licenses 3

Addresses

Electronic endpoints 1

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

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

{
    "created_epoch": "1706832000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1714003200000",
    "number": "1194588962",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1550 SHERIDAN DR STE 302",
            "city": "LANCASTER",
            "state": "OH",
            "postal_code": "431301380",
            "telephone_number": "740-901-3040"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1550 SHERIDAN DR STE 302",
            "city": "LANCASTER",
            "state": "OH",
            "postal_code": "431301380",
            "telephone_number": "740-901-3040"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "DERSAM",
        "first_name": "CARISSA",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2024-02-02",
        "last_updated": "2024-04-25",
        "certification_date": "2024-04-25",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "101YA0400X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Counselor, Addiction (Substance Use Disorder)",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "101YM0800X",
            "taxonomy_group": "",
            "desc": "Counselor, Mental Health",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "171M00000X",
            "taxonomy_group": "",
            "desc": "Case Manager/Care Coordinator",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "cdersam@rurecoveryinc.com",
            "affiliation": "N",
            "endpointDescription": "email",
            "use": "DIRECT",
            "useDescription": "Direct",
            "address_1": "1550 Sheridan Dr Ste 302",
            "city": "Lancaster",
            "state": "OH",
            "country_code": "US",
            "postal_code": "431301380",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

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• Jenevieve Pilar Dersam
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• Jerry William Detwiler, DDS
• Jon P Detwiler, DDS
• Prithvia Rachel Devadas, DO

• Case Manager/Care Coordinator in Lancaster, OH
• Providers in Lancaster, OH by specialty
• Case Manager/Care Coordinator in Ohio

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 25, 2024; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.