Derrick Schutrum

Primary specialty

Family Medicine PhysicianTaxonomy code 207Q00000X

License

024885 Issued in NY

Practice address

4893 Transit Rd
Depew, NY 14043-4698

Phone

(716) 608-7040

NPI assigned

Jun 9, 2020

Sex

Male

Sole proprietor

No

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

Specialties & licenses 2

Addresses

Medicare fee-for-service enrollment

Enrolled in NY

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: Yes
• Power mobility devices: Yes
• Hospice: No

Green means eligible to order or refer.

Enrollment records 1

Specialty

Physician Assistant

Education

Other, 2019

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

Southgate Medical Group LLPGroup PAC ID 7911810189, 31 clinicians

Practice addresses (Care Compare)

Hospital & facility affiliations

• Sisters of Charity Hospital Hospital, Buffalo, NY, CCN 330078

Medicare enrollment (NPD)

Enrolled

Credentials

Physician Assistant

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.

• Southgate Medical Group,LLP

  • Internal Medicine Physician
  • West Seneca, NY
  • NPI 1487611927
  Medicare reassignment Care Compare group
• General Physician, PC

  • General Practice Physician
  • Dunkirk, NY
  • NPI 1093959322
  Medicare reassignment

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

• Sisters of Charity Hospital of Buffalo New York

  • General Acute Care Hospital
  • Cheektowaga, NY
  • NPI 1043455199
  Care Compare affiliation
• Sisters of Charity Hospital of Buffalo New York

  • General Acute Care Hospital
  • Buffalo, NY
  • NPI 1790727543
  Care Compare affiliation

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

{
    "created_epoch": "1591660800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1591660800000",
    "number": "1295350940",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1961 BUSH RD",
            "city": "GRAND ISLAND",
            "state": "NY",
            "postal_code": "140722915",
            "telephone_number": "716-936-4334"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4893 TRANSIT RD",
            "city": "DEPEW",
            "state": "NY",
            "postal_code": "140434698",
            "telephone_number": "716-608-7040"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "SCHUTRUM",
        "first_name": "DERRICK",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2020-06-09",
        "last_updated": "2020-06-09",
        "certification_date": "2020-06-09",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "NY",
            "license": null,
            "primary": false
        },
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "NY",
            "license": "024885",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Hailey Schoenhardt, PA-C
• Dana Leann Scholl
• Anne Marie Schukraft, PT
• Cele Sarai Schulz, MS, DNP
• Christina Schunke, ANP-C
• Schutz Optical Co Inc
• Richard J. Schwartz, O.D.
• David Joseph Schwegmann, D.D.S.
• Thomas Michael Scibor, D.D.S.
• Derrick Matthew Sekuterski, PT

• Family Medicine Physician in Depew, NY
• Providers in Depew, NY by specialty
• Family Medicine Physician in New York

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 9, 2020; 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.