NPIMap

Individual provider Active NPI

John Gayle Van Derwood, M.D.

  • Family Medicine Physician
  • Daphne, AL
National Provider Identifier
1205949013
Registry record updated Dec 20, 2014
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Medicine PhysicianTaxonomy code 207Q00000X
License
11539 Issued in AL
Practice address
7101 US Highway 90
Suite 202
Daphne, AL 36526-9512
Phone
(251) 625-8211
Fax
(251) 625-8219
NPI assigned
Aug 16, 2006
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Dec 20, 2014

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Family Medicine Physician 207Q00000X 14230 MS
Family Medicine Physician 207Q00000X 11539 AL Primary

Addresses

Primary practice location

7101 US Highway 90
Suite 202
Daphne, AL 36526-9512

Mailing address

7101 US Highway 90
Suite 202
Daphne, AL 36526-9512
Phone (251) 625-8211

Other identifiers 2

IdentifierTypeStateIssuer
510-04616OtherALBLUE CROSS OF AL
051558401MedicaidAL

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in AL
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
I20070215000184 AL Practitioner - Family Practice 2466426937 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Family Practice
Education
University of Alabama School of Medicine, 1983
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Imc-Diagnostic and Medical Clinic LLCGroup PAC ID 2860399623, 168 clinicians

Practice addresses (Care Compare)

1700 Spring Hill Ave
Suite 100
Mobile, AL 36604-1416

1700 Springhill Ave
Suite 100
Mobile, AL 36604-1416
Phone (251) 435-1200

Hospital & facility affiliations

  • Thomas Hospital Hospital, Fairhope, AL, CCN 010100
  • Mobile Infirmary Medical Center Hospital, Mobile, AL, CCN 010113
  • North Baldwin Infirmary Hospital, Bay Minette, AL, CCN 010129

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
11539ALMDFamily Medicine Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Imc-Diagnostic and Medical Clinic LLC CurrentSince Jul 1, 2015 Accepting new patients
Imc-Diagnostic and Medical Clinic LLC Family Medicine CurrentSince Jul 1, 2015 Accepting new patients
Inpatient Physician Services Past Accepting new patients
Community Medical Center Family Medicine Past Accepting new patients
Mobile Infirmary Association Past Accepting new patients

Locations

7101 US Highway 90
Ste 202
Daphne, AL 36526
Phone (251) 625-8211

1700 Spring Hill Ave
Ste 100
Mobile, AL 36604

1725 Spring Hill Ave
Mobile, AL 36604
Phone (251) 435-1366

Interoperability endpoints

  • FHIR API: https://fhir4.healow.com/fhir/r4/IBHCBA
  • Direct secure messaging: jvanderwood51015@directinfirmaryhealth.org

Organizations & group practices 5

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": "1155686400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1419033600000",
    "number": "1205949013",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "7101 US HIGHWAY 90",
            "address_2": "SUITE 202",
            "city": "DAPHNE",
            "state": "AL",
            "postal_code": "365269512",
            "telephone_number": "251-625-8211",
            "fax_number": "251-625-8219"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "7101 US HIGHWAY 90",
            "address_2": "SUITE 202",
            "city": "DAPHNE",
            "state": "AL",
            "postal_code": "365269512",
            "telephone_number": "251-625-8211",
            "fax_number": "251-625-8219"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "VAN DERWOOD",
        "first_name": "JOHN",
        "middle_name": "GAYLE",
        "name_prefix": "Dr.",
        "credential": "M.D.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-08-16",
        "last_updated": "2014-12-20",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "MS",
            "license": "14230",
            "primary": false
        },
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "AL",
            "license": "11539",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BLUE CROSS OF AL",
            "identifier": "510-04616",
            "state": "AL"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "051558401",
            "state": "AL"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Daphne, AL

Sources for this page

Verify at the official NPI Registry.