James L. Derrico DDS LLC

Primary specialty

Customized Equipment (DME)Taxonomy code 332BC3200X

Legal business name

JAMES L. DERRICO DDS LLC

Practice address

1130 S Hwy 89
Jackson, WY 83001-8512

Phone

(307) 200-6644

NPI assigned

Jul 2, 2021

Organization subpart

No

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

Authorized official

Name

Dr. James L Derrico, DDSNPI 1891801585

Title

Owner

Phone

(630) 399-7367

Specialties & licenses 2

Addresses

Electronic endpoints 1

Medicare fee-for-service enrollment

Enrolled in WY

Enrollment records 1

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

• James L Derrico, DDS, LLC

  • Dentist
  • Jackson, WY
  • NPI 1891801585
  NPD Authorized official

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

{
    "created_epoch": "1625184000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1691020800000",
    "number": "1235700014",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 806",
            "city": "JACKSON",
            "state": "WY",
            "postal_code": "830010806",
            "telephone_number": "630-399-7367"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1130 S HWY 89",
            "city": "JACKSON",
            "state": "WY",
            "postal_code": "830018512",
            "telephone_number": "307-200-6644"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "JAMES L. DERRICO DDS LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2021-07-02",
        "last_updated": "2023-08-03",
        "certification_date": "2023-08-03",
        "status": "A",
        "authorized_official_last_name": "DERRICO",
        "authorized_official_first_name": "JAMES",
        "authorized_official_middle_name": "L",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "630-399-7367",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "DDS"
    },
    "taxonomies": [
        {
            "code": "261QD0000X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Dental",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "332BC3200X",
            "taxonomy_group": "",
            "desc": "Durable Medical Equipment & Medical Supplies, Customized Equipment",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [
        {
            "endpointType": "OTHERS",
            "endpointTypeDescription": "Other URL",
            "endpoint": "teton.sleep.solutions@gmail.com",
            "affiliation": "N",
            "address_1": "1130 S 89 Hwy",
            "city": "Jackson",
            "state": "WY",
            "country_code": "US",
            "postal_code": "83001",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

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• William Jackson, RPH
• JBG Consulting
• Jeffrey Greenbaum MD
• James Richard Jenkins
• Adam Johnson, M.D.
• Camden Johnson

• Customized Equipment (DME) in Jackson, WY
• Providers in Jackson, WY by specialty
• Customized Equipment (DME) in Wyoming

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 3, 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.