Kathryn Jenny Derrick, PA-C

Primary specialty

Physician AssistantTaxonomy code 363A00000X

License

PA9111539 Issued in FL

Practice address

991 E del Webb Blvd
Sun City Center, FL 33573-6669

Phone

(813) 978-9700

NPI assigned

Sep 25, 2018

Last updated

Jan 18, 2023By the provider in NPPES

Sex

Female

Sole proprietor

No

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

Specialties & licenses 2

Addresses

Other identifiers 1

Medicare fee-for-service enrollment

Enrolled in FL

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: Yes
• Power mobility devices: Yes
• Hospice: No

Green means eligible to order or refer.

Enrollment records 1

Specialty

Physician Assistant

Education

Other, 2018

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

Florida Anesthesia Medical Services 1, PAGroup PAC ID 7416208434, 10 clinicians

Practice addresses (Care Compare)

Hospital & facility affiliations

• Tampa General Hospital Hospital, Tampa, FL, CCN 100128

Medicare enrollment (NPD)

Enrolled

Credentials

Physician Assistant

State licenses

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, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

• Florida Anesthesia Medical Services 1, PA

  • Pain Medicine (Anesthesiology) Physician
  • Sun City Center, FL
  • NPI 1467949776
  Medicare reassignment Care Compare group
• Gulf-to-Bay Anesthesiology Associates LLC

  • Anesthesiology Physician
  • Tampa, FL
  • NPI 1720039746
  Medicare reassignment NPD
• Musculoskeletal Institute Chartered

  dba Florida Orthopaedic Institute

  • Orthopaedic Surgery Physician
  • Temple Terrace, FL
  • NPI 1386639920
  Medicare reassignment NPD
• Tallahassee Orthopedic Clinic III PL

  dba Tallahassee Orthopedic Clinic

  • Medical Specialty Clinic/Center
  • Tallahassee, FL
  • NPI 1194778050
  Medicare reassignment
• Gulf-to-Bay Anesthesiology Associates LLC

  • Anesthesiology Physician
  • Largo, FL
  • NPI 1316205339
  NPD
• Musculoskeletal Institute Chartered

  • Orthopaedic Surgery Physician
  • Zephyrhills, FL
  • NPI 1467305839
  NPD
• Tallahassee Orthopedic Clinic III, P.L.

  • Durable Medical Equipment & Medical Supplies
  • Panama City Beach, FL
  • NPI 1497617948
  NPD

Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.

• Florida Health Sciences Center Inc

  dba Tampa General Hospital

  • General Acute Care Hospital
  • Tampa, FL
  • NPI 1235196510
  Care Compare affiliation

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

{
    "created_epoch": "1537833600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1674000000000",
    "number": "1215412309",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "13020 N TELECOM PKWY",
            "city": "TEMPLE TERRACE",
            "state": "FL",
            "postal_code": "336370915",
            "telephone_number": "813-978-9700"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "991 E DEL WEBB BLVD",
            "city": "SUN CITY CENTER",
            "state": "FL",
            "postal_code": "335736669",
            "telephone_number": "813-978-9700"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "DERRICK",
        "first_name": "KATHRYN",
        "middle_name": "JENNY",
        "name_prefix": "Ms.",
        "credential": "PA-C",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2018-09-25",
        "last_updated": "2023-01-18",
        "certification_date": "2023-01-18",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "FL",
            "license": "PA9111539",
            "primary": true
        },
        {
            "code": "363AS0400X",
            "taxonomy_group": "",
            "desc": "Physician Assistant, Surgical",
            "state": "FL",
            "license": "9111539",
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "101229400",
            "state": "FL"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Dental Associates of Central Florida
• Dental Associates of Florida - Cosmetic and Implant Dentistry PLLC (DAF Cosmetic and Implant Dentistry)
• Dental Associates of Florida (Sun City Center) PLLC
• Dental Associates of Suncity
• Dental Experts of Florida
• Pamela L Detrick, MHNP
• Vijayalakshmi Dhaduvai, M.D.
• Joseph Frank Diaz, DDS
• Nicollette Dibenedetto, LMHC
• Lorenzo Dickens Jr., PHARM D.

• Physician Assistant in Sun City Center, FL
• Providers in Sun City Center, FL by specialty
• Physician Assistant in Florida

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 18, 2023; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.