Individual provider Active NPI

Derrick Lamar Reedus Sr., M.D.

  • Urology Physician
  • Newark, OH
National Provider Identifier
1194929463
Registry record updated Jan 25, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Urology PhysicianTaxonomy code 208800000X
License
35.090640 Issued in OH
Practice address
1980 Tamarack Rd
Newark, OH 43055-1363
Phone
(220) 564-7520
Fax
(220) 564-7521
NPI assigned
Jun 12, 2007
Sex
Male
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Jan 25, 2024

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Urology Physician 208800000X 35.090640 OH Primary

Addresses

Primary practice location

1980 Tamarack Rd
Newark, OH 43055-1363

Mailing address

1320 W Main St
Newark, OH 43055-1822
Phone (220) 564-4027

Other practice location 1

4000 Miamisburg Centerville Rd Ste 450
Miamisburg, OH 45342-3908
Phone (937) 560-2011

Electronic endpoints 3

TypeEndpointUseAffiliation
Direct Messaging Address dreedus25199@lickingmemorial.medicity.net
FHIR URL https:/khnarr.ketthealth.com/FHIR-PROD/api/FHIR/R4/
Direct Messaging Address dreedus891417@direct.ketteringhealth.org

Medicare participation

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

Enrollment IDStateProvider typePAC IDDetails
I20080509000422 OH Practitioner - Urology 8022197482 Reassigns benefits to 2 organizations

Care Compare profile

Medicare Care Compare
Specialty
Urology
Education
Northeastern Ohio University College of Medicine, 2002
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Kettering Independent Medical Group IncGroup PAC ID 3173710936, 699 clinicians
Genesis Medical Group, LLCGroup PAC ID 7719040385, 265 clinicians

Practice addresses (Care Compare)

4000 Miamisburg Centerville Rd
Suite 450
Miamisburg, OH 45342-3908
Phone (937) 560-2011

751 Forest Ave
Suite 301
Zanesville, OH 43701-2875
Phone (740) 454-0804

Hospital & facility affiliations

  • Genesis Hospital Hospital, Zanesville, OH, CCN 360039

Merit-based Incentive Payment System (MIPS)

Final score
81.34 of 100Reported as group
Quality
63.67
Promoting interoperability
100
Improvement activities
40
Cost
74.14

Merit-based Incentive Payment System (MIPS)

Final score
85.98 of 100Reported as group
Quality
75.66
Promoting interoperability
100
Improvement activities
40
Cost
75.38

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
35.090640OHMDUrology Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Genesis Medical Group, LLC CurrentSince Jan 24, 2025 Accepting new patients
Genesis Medical Group LLC CurrentSince Jan 24, 2025 Accepting new patients
Kettering Independent Medical Group Inc CurrentSince Aug 11, 2023 Accepting new patients
Alliance Physicians Inc Current Accepting new patients
Adena Medical Group LLC Urology Past Accepting new patients
Licking Memorial Professional Corp. Past Accepting new patients

Locations

4403 Far Hills Ave
Kettering, OH 45429
Phone (937) 395-3910

1 Prestige Pl
Ste 550
Miamisburg, OH 45342
Phone (937) 752-2306

4000 Miamisburg Centerville Rd
Ste 450
Miamisburg, OH 45342
Phone (937) 439-3600

945 Bethesda Dr
Ste 330
Zanesville, OH 43701
Phone (740) 454-4038

751 Forest Ave
Ste 301
Zanesville, OH 43701
Phone (740) 454-0804

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 4

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": "1181606400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1706140800000",
    "number": "1194929463",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1320 W MAIN ST",
            "city": "NEWARK",
            "state": "OH",
            "postal_code": "430551822",
            "telephone_number": "220-564-4027"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1980 TAMARACK RD",
            "city": "NEWARK",
            "state": "OH",
            "postal_code": "430551363",
            "telephone_number": "220-564-7520",
            "fax_number": "220-564-7521"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "4000 Miamisburg Centerville Rd Ste 450",
            "address_purpose": "LOCATION",
            "city": "Miamisburg",
            "state": "OH",
            "postal_code": "453423908",
            "country_code": "US",
            "telephone_number": "937-560-2011",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "REEDUS",
        "first_name": "DERRICK",
        "middle_name": "LAMAR",
        "name_prefix": "Dr.",
        "name_suffix": "Sr.",
        "credential": "M.D.",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2007-06-12",
        "last_updated": "2024-01-25",
        "certification_date": "2024-01-25",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "208800000X",
            "taxonomy_group": "",
            "desc": "Urology",
            "state": "OH",
            "license": "35.090640",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "dreedus25199@lickingmemorial.medicity.net",
            "affiliation": "N",
            "address_1": "1980 Tamarack Rd",
            "city": "Newark",
            "state": "OH",
            "country_code": "US",
            "postal_code": "430551363",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "endpointType": "FHIR",
            "endpointTypeDescription": "FHIR URL",
            "endpoint": "https:/khnarr.ketthealth.com/FHIR-PROD/api/FHIR/R4/",
            "affiliation": "N",
            "address_1": "4000 Miamisburg Centerville Rd Ste 450",
            "city": "Miamisburg",
            "state": "OH",
            "country_code": "US",
            "postal_code": "453423908",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "dreedus891417@direct.ketteringhealth.org",
            "affiliation": "N",
            "address_1": "4000 Miamisburg Centerville Rd Ste 450",
            "city": "Miamisburg",
            "state": "OH",
            "country_code": "US",
            "postal_code": "453423908",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

Other providers in Newark, OH

Sources for this page

Verify at the official NPI Registry.