Active NPI
Ericus T Derks
- Physical Therapist
- Pontiac, MI
National Provider Identifier
1255458238
On this page
OIG exclusion record
The HHS Office of Inspector General’s List of Excluded Individuals/Entities (LEIE) contains a record with this NPI:
- Section 1128a(2) exclusion effective Oct 20, 2014.
Key facts
NPPES NPI Registry- Primary specialty
- Physical Therapist
- License
- 5501005585
- Practice address
- 1915 N Perry St
Pontiac, MI 48340-2237 - Phone
- (615) 778-4066
- NPI assigned
- Mar 23, 2007
- Sex
- Male
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Physical Therapist | 225100000X | 5501005585 | MI | Primary |
Addresses
Primary practice location
1915 N Perry St
Pontiac, MI 48340-2237
Mailing address
720 Cool Springs Blvd
Suite 300
Franklin, TN 37067-2626
Phone (615) 778-4066
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)
- Not enrolled
- HHS exclusion list flag
- Flagged The directory lists this NPI on an HHS exclusion list.
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 5501005585 | MI | MD | Physical Therapist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1174608000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1183852800000",
"number": "1255458238",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "720 COOL SPRINGS BLVD",
"address_2": "SUITE 300",
"city": "FRANKLIN",
"state": "TN",
"postal_code": "370672626",
"telephone_number": "615-778-4066",
"fax_number": "615-778-9114"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1915 N PERRY ST",
"city": "PONTIAC",
"state": "MI",
"postal_code": "483402237",
"telephone_number": "615-778-4066"
}
],
"practiceLocations": [],
"basic": {
"last_name": "DERKS",
"first_name": "ERICUS",
"middle_name": "T",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2007-03-23",
"last_updated": "2007-07-08",
"status": "A"
},
"taxonomies": [
{
"code": "225100000X",
"taxonomy_group": "",
"desc": "Physical Therapist",
"state": "MI",
"license": "5501005585",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Pontiac, MI
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 8, 2007; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; OIG LEIE.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.