Active NPI
Derrick Anthony Davis, MPH, PA-C
- Medical Physician Assistant
- Pembroke Pines, FL
National Provider Identifier
1285771808
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Medical Physician Assistant
- License
- 9103680
- Practice address
- 320 S Flamingo Rd
# 112
Pembroke Pines, FL 33027-1770 - Phone
- (954) 558-6324
- NPI assigned
- Jan 31, 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 |
|---|---|---|---|---|
| Medical Physician Assistant | 363AM0700X | 9103680 | FL | Primary |
Addresses
Primary practice location
320 S Flamingo Rd
# 112
Pembroke Pines, FL 33027-1770
Mailing address
320 S Flamingo Rd
# 112
Pembroke Pines, FL 33027-1770
Phone (954) 558-6324
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
- Physician Assistant
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 9103680 | FL | MD | Medical Physician Assistant |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Multi-Specialty Medical Consultants PLLC | Current | Accepting new patients | |
| J.R.P. Diagnostics & Rehab, Inc | Past | Accepting new patients |
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.
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NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1170201600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1376438400000",
"number": "1285771808",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "320 S FLAMINGO RD",
"address_2": "# 112",
"city": "PEMBROKE PINES",
"state": "FL",
"postal_code": "330271770",
"telephone_number": "954-558-6324"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "320 S FLAMINGO RD",
"address_2": "# 112",
"city": "PEMBROKE PINES",
"state": "FL",
"postal_code": "330271770",
"telephone_number": "954-558-6324"
}
],
"practiceLocations": [],
"basic": {
"last_name": "DAVIS",
"first_name": "DERRICK",
"middle_name": "ANTHONY",
"name_prefix": "Mr.",
"credential": "MPH, PA-C",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2007-01-31",
"last_updated": "2013-08-14",
"status": "A"
},
"taxonomies": [
{
"code": "363AM0700X",
"taxonomy_group": "",
"desc": "Physician Assistant, Medical",
"state": "FL",
"license": "9103680",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Pembroke Pines, FL
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 14, 2013; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.