NPIMap

Individual provider Active NPI

Derek V Booton, MD

  • Anesthesiology Physician
  • Nashville, TN
National Provider Identifier
1255310710
Registry record updated Nov 29, 2018
On this page

Key facts

NPPES NPI Registry
Primary specialty
Anesthesiology PhysicianTaxonomy code 207L00000X
License
58170 Issued in TN
Practice address
110 29TH Ave N Ste 202
Nashville, TN 37203-1448
Phone
(615) 327-4304
Fax
(615) 327-7940
NPI assigned
Jan 12, 2006
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Nov 29, 2018

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Anesthesiology Physician 207L00000X 58170 TN Primary
Anesthesiology Physician 207L00000X 036102911 IL

Addresses

Primary practice location

110 29TH Ave N Ste 202
Nashville, TN 37203-1448

Mailing address

PO Box 17037
Urbana, IL 61803-7037
Phone (800) 897-6169

Other practice location 1

701 N 1st St
Springfield, IL 62781-0001
Phone (217) 788-5495

Other identifiers 2

IdentifierTypeStateIssuer
036102911OtherILBC OF IL
036102911MedicaidIL

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Not listed in the public Medicare enrollment file

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
036102911ILMDAnesthesiology Physician
58170TNMDAnesthesiology Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Clinical Radiologists, S.C. Past Accepting new patients
Westport Anesthesia Services of Missouri, PC Anesthesiology Past Accepting new patients
Truman Medical Centers, Inc. Past Accepting new patients
University Health Physicians Past Accepting new patients

Organizations & group practices 4

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.

NPI Registry JSON

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

{
    "created_epoch": "1137024000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1543449600000",
    "number": "1255310710",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 17037",
            "city": "URBANA",
            "state": "IL",
            "postal_code": "618037037",
            "telephone_number": "800-897-6169",
            "fax_number": "800-897-6170"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "110 29TH AVE N STE 202",
            "city": "NASHVILLE",
            "state": "TN",
            "postal_code": "372031448",
            "telephone_number": "615-327-4304",
            "fax_number": "615-327-7940"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "701 N 1st St",
            "address_purpose": "LOCATION",
            "city": "Springfield",
            "state": "IL",
            "postal_code": "627810001",
            "country_code": "US",
            "telephone_number": "217-788-5495",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "BOOTON",
        "first_name": "DEREK",
        "middle_name": "V",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-01-12",
        "last_updated": "2018-11-29",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207L00000X",
            "taxonomy_group": "",
            "desc": "Anesthesiology",
            "state": "TN",
            "license": "58170",
            "primary": true
        },
        {
            "code": "207L00000X",
            "taxonomy_group": "",
            "desc": "Anesthesiology",
            "state": "IL",
            "license": "036102911",
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BC OF IL",
            "identifier": "036102911",
            "state": "IL"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "036102911",
            "state": "IL"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Nashville, TN

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 29, 2018; 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.