Individual provider Active NPI

Derek Philip Watson, MD

  • Physical Medicine & Rehabilitation Physician
  • Raleigh, NC
National Provider Identifier
1255524435
Registry record updated Feb 27, 2019
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physical Medicine & Rehabilitation PhysicianTaxonomy code 208100000X
License
2008-00177 Issued in NC
Practice address
11200 Governor Manly Way Ste 309
Raleigh, NC 27614-7375
Phone
(919) 562-9410
Fax
(919) 562-2948
NPI assigned
Aug 22, 2007
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Feb 27, 2019

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Orthopaedic Surgery Physician 207X00000X 2008-00177 NC
Physical Medicine & Rehabilitation Physician 208100000X 2008-00177 NC Primary

Addresses

Primary practice location

11200 Governor Manly Way Ste 309
Raleigh, NC 27614-7375

Mailing address

PO Box 1107
Wake Forest, NC 27588-1107
Phone (919) 562-9410

Other practice location 1

6602 Knightdale Blvd Ste 310
Knightdale, NC 27545-6526
Phone (919) 562-9410

Other practice location 2

200 W Parkview Dr Ste B
Henderson, NC 27536-5958
Phone (919) 562-9410

Other practice location 3

103 Professional Park Ste A
Oxford, NC 27565-2581
Phone (919) 562-9410

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in NC
Eligible to order & refer
  • Part B services: Yes
  • Medical equipment: Yes
  • Home health: Yes
  • Power mobility devices: Yes
  • Hospice: Yes
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20080813000632 NC Practitioner - Physical Medicine and Rehabilitation 4587739313 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Physical Medicine and Rehabilitation
Education
Brody School of Medicine at East Carolina University, 2004
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Orthopaedic Specialists of North Carolina, P.a.Group PAC ID 7810974375, 49 clinicians
Proactive Therapy of North Carolina IncGroup PAC ID 6305753120, shared by 5 NPIs, 540 clinicians
Legacy Healthcare Services IncGroup PAC ID 2163339722, shared by 46 NPIs, 3,431 clinicians

Practice addresses (Care Compare)

11221 Galleria Ave
Suite 101
Raleigh, NC 27614-8137
Phone (919) 562-9410

2303 Wellington Dr SW
Suite B
Wilson, NC 27893-8620
Phone (252) 243-6818

2701 Pickett Rd
Durham, NC 27705-5688
Phone (919) 419-9600

Hospital & facility affiliations

  • Wakemed, Raleigh Campus Hospital, Raleigh, NC, CCN 340069

Merit-based Incentive Payment System (MIPS)

Final score
85.17 of 100Reported as individual
Quality
77.12
Promoting interoperability
100
Improvement activities
40
Cost
73.45

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
2008-00177NCMDPhysical Medicine & Rehabilitation Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Orthopaedic Specialists of North Carolina, P.a. Orthopaedic Surgery CurrentSince Sep 1, 2008 Accepting new patients
Orthopaedic Specialists of North Carolina, P.a. Orthopaedic Surgery CurrentSince Sep 1, 2008 Accepting new patients

Locations

200 W Parkview Dr
#B
Henderson, NC 27536

6602 Knightdale Blvd
Ste 310
Knightdale, NC 27545

103 Professional Park
Ste A
Oxford, NC 27565
Phone (919) 693-7108

5838 Six Forks Rd
Ste 300
Raleigh, NC 27609
Phone (919) 782-5954

5838 Six Forks Rd
Ste 100
Raleigh, NC 27609

11200 Governor Manly Way
Ste 309
Raleigh, NC 27614
Phone 9195629410247

5838 Six Forks Rd
Raleigh, NC 27609
Phone (919) 847-1100

11221 Galleria Ave
#101
Raleigh, NC 27614
Phone 9195629410213

1936 Golden Spur Ln
Wendell, NC 27591

Interoperability endpoints

  • Direct secure messaging: derek.watson.1@12529.direct.athenahealth.com
  • Direct secure messaging: dwatson11539@direct.unc.nchie.net

Organizations & group practices 2

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 2

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": "1187740800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1551225600000",
    "number": "1255524435",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 1107",
            "city": "WAKE FOREST",
            "state": "NC",
            "postal_code": "275881107",
            "telephone_number": "919-562-9410"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "11200 GOVERNOR MANLY WAY STE 309",
            "city": "RALEIGH",
            "state": "NC",
            "postal_code": "276147375",
            "telephone_number": "919-562-9410",
            "fax_number": "919-562-2948"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "6602 Knightdale Blvd Ste 310",
            "address_purpose": "LOCATION",
            "city": "Knightdale",
            "state": "NC",
            "postal_code": "275456526",
            "country_code": "US",
            "telephone_number": "919-562-9410",
            "fax_number": "919-562-2948",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "200 W Parkview Dr Ste B",
            "address_purpose": "LOCATION",
            "city": "Henderson",
            "state": "NC",
            "postal_code": "275365958",
            "country_code": "US",
            "telephone_number": "919-562-9410",
            "fax_number": "919-562-2948",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "103 Professional Park Ste A",
            "address_purpose": "LOCATION",
            "city": "Oxford",
            "state": "NC",
            "postal_code": "275652581",
            "country_code": "US",
            "telephone_number": "919-562-9410",
            "fax_number": "919-562-2948",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "WATSON",
        "first_name": "DEREK",
        "middle_name": "PHILIP",
        "name_prefix": "Dr.",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2007-08-22",
        "last_updated": "2019-02-27",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207X00000X",
            "taxonomy_group": "",
            "desc": "Orthopaedic Surgery",
            "state": "NC",
            "license": "2008-00177",
            "primary": false
        },
        {
            "code": "208100000X",
            "taxonomy_group": "",
            "desc": "Physical Medicine & Rehabilitation",
            "state": "NC",
            "license": "2008-00177",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Raleigh, NC

Sources for this page

Verify at the official NPI Registry.