Dustin Clifton Derrick, M.D.

Primary specialty

Plastic Surgery PhysicianTaxonomy code 208200000X

License

Q4085 Issued in TX

Practice address

800 12TH Ave Ste 100
Fort Worth, TX 76104-2519

Phone

(817) 810-0770

Fax

(817) 820-0242

NPI assigned

Aug 3, 2010

Sex

Male

Sole proprietor

Yes

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

Specialties & licenses 3

Addresses

Medicare fee-for-service enrollment

Enrolled in TX

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

Specialty

Plastic and Reconstructive Surgery

Education

University of Texas Medical School at San Antonio, 2010

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

Texas Plastic Surgery Associates, PAGroup PAC ID 3274708797, 4 clinicians

Practice addresses (Care Compare)

Hospital & facility affiliations

• Texas Health Harris Methodist Fort Worth Hospital, Fort Worth, TX, CCN 450135

Procedures performed for Medicare patients

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Medicine

State licenses

Practice roles

Locations

Interoperability endpoints

• Direct secure messaging: dderrick@directaddress.net

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.

• Texas Plastic Surgery Associates, PA

  • Plastic Surgery Physician
  • Fort Worth, TX
  • NPI 1568740892

  Single Specialty

  Medicare reassignment Care Compare group NPD
• Texas Plastic Surgery Associates, PA

  • Plastic Surgery Physician
  • Fort Worth, TX
  • NPI 1467730796

  Single Specialty

  NPD

Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.

• Texas Health Harris Methodist Hospital Fort Worth

  • General Acute Care Hospital
  • Fort Worth, TX
  • NPI 1336172105
  Care Compare affiliation

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

{
    "created_epoch": "1280793600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1634083200000",
    "number": "1295049070",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "800 12TH AVE STE 100",
            "city": "FORT WORTH",
            "state": "TX",
            "postal_code": "761042519",
            "telephone_number": "817-810-0770",
            "fax_number": "817-820-0242"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "800 12TH AVE STE 100",
            "city": "FORT WORTH",
            "state": "TX",
            "postal_code": "761042519",
            "telephone_number": "817-810-0770",
            "fax_number": "817-820-0242"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "DERRICK",
        "first_name": "DUSTIN",
        "middle_name": "CLIFTON",
        "name_prefix": "Dr.",
        "credential": "M.D.",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2010-08-03",
        "last_updated": "2021-10-13",
        "certification_date": "2021-10-13",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "208600000X",
            "taxonomy_group": "",
            "desc": "Surgery",
            "state": "TX",
            "license": "Q4085",
            "primary": false
        },
        {
            "code": "390200000X",
            "taxonomy_group": "",
            "desc": "Student in an Organized Health Care Education/Training Program",
            "state": "OH",
            "license": "57. 025880",
            "primary": false
        },
        {
            "code": "208200000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Plastic Surgery",
            "state": "TX",
            "license": "Q4085",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Dept of Assistive & Rehab Serv - Fort Worth Field Headquarters
• Ivan Manuel Dequesada II, M.D.
• Morgan Ann Derby
• Maya Derhake, MS, CGC
• John Derouin Jr.
• Tiffany Ann Derrick, LPC-I
• Alicia Denee Derry, O.D.
• Martin A Derusha, DO
• Mina Girgis Deryas
• Alap Desai, M.D.

• Plastic Surgery Physician in Fort Worth, TX
• Providers in Fort Worth, TX by specialty
• Plastic Surgery Physician in Texas

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 13, 2021; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• 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.