Individual provider Active NPI

Derek Richard Herms, DC

  • Chiropractor
  • Southlake, TX
National Provider Identifier
1285867465
Registry record updated Sep 3, 2009
On this page

Key facts

NPPES NPI Registry
Primary specialty
ChiropractorTaxonomy code 111N00000X
License
11119 Issued in TX
Practice address
1500 W Southlake Blvd
Suite 120
Southlake, TX 76092-5950
Phone
(817) 416-6116
Fax
(817) 410-9411
NPI assigned
Sep 3, 2009
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Sep 3, 2009

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Chiropractor 111N00000X 11119 TX Primary

Addresses

Primary practice location

1500 W Southlake Blvd
Suite 120
Southlake, TX 76092-5950

Mailing address

1500 W Southlake Blvd
Suite 120
Southlake, TX 76092-5950
Phone (817) 416-6116

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in TX

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20100104000400 TX Practitioner - Chiropractic 8921149675 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Chiropractic
Education
Other, 2009
Medicare assignment
Accepts the Medicare-approved amount as payment in full

Practice addresses (Care Compare)

3719 N Belt Line Rd
Irving, TX 75038-5702
Phone (972) 255-4443

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

Practice roles

OrganizationSpecialtyStatusNew patients
Southlake Physical Medicine PLLC CurrentSince Apr 12, 2017 Accepting new patients

Locations

1500 W Southlake Blvd
Ste 120
Southlake, TX 76092
Phone (817) 416-6116

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.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1251936000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1251936000000",
    "number": "1285867465",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1500 W SOUTHLAKE BLVD",
            "address_2": "SUITE 120",
            "city": "SOUTHLAKE",
            "state": "TX",
            "postal_code": "760925950",
            "telephone_number": "817-416-6116",
            "fax_number": "817-410-9411"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1500 W SOUTHLAKE BLVD",
            "address_2": "SUITE 120",
            "city": "SOUTHLAKE",
            "state": "TX",
            "postal_code": "760925950",
            "telephone_number": "817-416-6116",
            "fax_number": "817-410-9411"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "HERMS",
        "first_name": "DEREK",
        "middle_name": "RICHARD",
        "name_prefix": "Dr.",
        "credential": "DC",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2009-09-03",
        "last_updated": "2009-09-03",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "111N00000X",
            "taxonomy_group": "",
            "desc": "Chiropractor",
            "state": "TX",
            "license": "11119",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Southlake, TX

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 3, 2009; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.