NPIMap

Individual provider Active NPI

Derrick John Winckler, PAC

  • Surgical Physician Assistant
  • Lone Tree, CO
National Provider Identifier
1285076661
Registry record updated Oct 27, 2014
On this page

Key facts

NPPES NPI Registry
Primary specialty
Surgical Physician AssistantTaxonomy code 363AS0400X
License
0003752 Issued in CO
Practice address
10099 Ridgegate Pkwy
Suite 310
Lone Tree, CO 80124-5531
Phone
(303) 790-1800
Fax
(303) 790-1809
NPI assigned
Jul 25, 2013
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Oct 27, 2014

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Surgical Physician Assistant 363AS0400X 0003752 CO Primary

Addresses

Primary practice location

10099 Ridgegate Pkwy
Suite 310
Lone Tree, CO 80124-5531

Mailing address

10099 Ridgegate Pkwy
Suite 310
Lone Tree, CO 80124-5531
Phone (303) 790-1800

Other identifiers 1

IdentifierTypeStateIssuer
0003752OtherCOCO STATE LICENSE

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20131019000054 CO Practitioner - Physician Assistant 3577798974 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Physician Assistant
Education
Other, 2013
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Front Range Spine and NeurosurgeryGroup PAC ID 7214966720, 12 clinicians

Practice addresses (Care Compare)

10099 Ridgegate Pkwy
Suite 310
Lone Tree, CO 80124-5534
Phone (303) 790-1800

Hospital & facility affiliations

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Physician Assistant

State licenses

LicenseStateTypeSpecialty
0003752COMDSurgical Physician Assistant

Organizations & group practices 1

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 9

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": "1374710400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1414368000000",
    "number": "1285076661",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "10099 RIDGEGATE PKWY",
            "address_2": "SUITE 310",
            "city": "LONE TREE",
            "state": "CO",
            "postal_code": "801245531",
            "telephone_number": "303-790-1800",
            "fax_number": "303-790-1809"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "10099 RIDGEGATE PKWY",
            "address_2": "SUITE 310",
            "city": "LONE TREE",
            "state": "CO",
            "postal_code": "801245531",
            "telephone_number": "303-790-1800",
            "fax_number": "303-790-1809"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "WINCKLER",
        "first_name": "DERRICK",
        "middle_name": "JOHN",
        "credential": "PAC",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2013-07-25",
        "last_updated": "2014-10-27",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363AS0400X",
            "taxonomy_group": "",
            "desc": "Physician Assistant, Surgical",
            "state": "CO",
            "license": "0003752",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "CO STATE LICENSE",
            "identifier": "0003752",
            "state": "CO"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Lone Tree, CO

Sources for this page

Verify at the official NPI Registry.