NPIMap

Individual provider Active NPI

Deryck S Watermeyer, MD

  • Anesthesiology Physician
  • Tacoma, WA
National Provider Identifier
1285662296
Registry record updated Jul 8, 2007
On this page

Key facts

NPPES NPI Registry
Primary specialty
Anesthesiology PhysicianTaxonomy code 207L00000X
License
MD00027177 Issued in WA
Practice address
1717 S J St
Tacoma, WA 98405-4933
Phone
(253) 627-4930
Fax
(253) 627-4649
NPI assigned
Jun 29, 2006
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jul 8, 2007

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Anesthesiology Physician 207L00000X MD00027177 WA Primary

Addresses

Primary practice location

1717 S J St
Tacoma, WA 98405-4933

Mailing address

10420 Kopachuck Dr NW
Gig Harbor, WA 98335-5970

Other identifiers 3

IdentifierTypeStateIssuer
58268OtherL&I
8127623MedicaidWA
WA8431OtherD/S REGENCE 90

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in WA
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
I20101123000666 WA Practitioner - Anesthesiology 2567658065 Reassigns benefits to 2 organizations

Care Compare profile

Medicare Care Compare
Specialty
Anesthesiology
Education
Other, 1984
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Franciscan Medical GroupGroup PAC ID 0547173866, 1,400 clinicians

Practice addresses (Care Compare)

1717 S J St
Tacoma, WA 98405-4933
Phone (253) 426-6341

Hospital & facility affiliations

National Provider Directory

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

Practice roles

OrganizationSpecialtyStatusNew patients
Franciscan Medical Group Anesthesiology CurrentSince Jun 16, 2023 Accepting new patients
Franciscan Medical Group CurrentSince Jun 16, 2023 Accepting new patients
Franciscan Medical Group Current Accepting new patients
Pacific Anesthesia PC Anesthesiology CurrentSince Jul 1, 1991 Accepting new patients
Franciscan Medical Group Past Accepting new patients
Fox Medical Center PastSince Jun 27, 2021 Accepting new patients

Locations

1717 S J St
Tacoma, WA 98405
Phone (253) 426-4101

1812 S J St
Ste 120
Tacoma, WA 98405
Phone (253) 428-2200

1717 S J St
Stop 136
Tacoma, WA 98405

4620 Bridgeport Way W
University Place, WA 98466
Phone (253) 564-0170

Interoperability endpoints

  • Direct secure messaging: dwatermeyer12827@fhsce.catholichealth.net

Organizations & group practices 6

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

Hospital & facility affiliations 3

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": "1151539200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1183852800000",
    "number": "1285662296",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "10420 KOPACHUCK DR NW",
            "city": "GIG HARBOR",
            "state": "WA",
            "postal_code": "983355970"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1717 S J ST",
            "city": "TACOMA",
            "state": "WA",
            "postal_code": "984054933",
            "telephone_number": "253-627-4930",
            "fax_number": "253-627-4649"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "WATERMEYER",
        "first_name": "DERYCK",
        "middle_name": "S",
        "name_prefix": "Dr.",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-06-29",
        "last_updated": "2007-07-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207L00000X",
            "taxonomy_group": "",
            "desc": "Anesthesiology",
            "state": "WA",
            "license": "MD00027177",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "L&I",
            "identifier": "58268",
            "state": null
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "8127623",
            "state": "WA"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "D/S REGENCE 90",
            "identifier": "WA8431",
            "state": null
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Tacoma, WA

Sources for this page

Verify at the official NPI Registry.