Active NPI
Derek A McClellan, M.D.
- Pediatrics Physician
- Westerville, OH
National Provider Identifier
1295760726
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Pediatrics Physician
- License
- 35.35075108
- Practice address
- 507 Executive Campus Dr
Suite 160
Westerville, OH 43082-9838 - Phone
- (614) 891-9505
- Fax
- (614) 891-6416
- NPI assigned
- Jul 12, 2006
- 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 |
|---|---|---|---|---|
| Pediatrics Physician | 208000000X | 35.35075108 | OH | Primary |
Addresses
Primary practice location
507 Executive Campus Dr
Suite 160
Westerville, OH 43082-9838
Mailing address
507 Executive Campus Dr
Suite 160
Westerville, OH 43082-9838
Phone (614) 891-9505
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 2160781 | Medicaid | OH |
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)
- Not enrolled
- Credentials
- Doctor of Medicine
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 35.35075108 | OH | MD | Pediatrics Physician |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Central Ohio Primary Care Physicians Inc | Current | Accepting new patients |
Interoperability endpoints
- dmcclellan19123@copcp.medicity.net
Organizations & group practices 1
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.
-
- Hospitalist Physician
- Westerville, OH
- NPI 1518398866
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1152662400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1221436800000",
"number": "1295760726",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "507 EXECUTIVE CAMPUS DR",
"address_2": "SUITE 160",
"city": "WESTERVILLE",
"state": "OH",
"postal_code": "430829838",
"telephone_number": "614-891-9505",
"fax_number": "614-891-6416"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "507 EXECUTIVE CAMPUS DR",
"address_2": "SUITE 160",
"city": "WESTERVILLE",
"state": "OH",
"postal_code": "430829838",
"telephone_number": "614-891-9505",
"fax_number": "614-891-6416"
}
],
"practiceLocations": [],
"basic": {
"last_name": "MCCLELLAN",
"first_name": "DEREK",
"middle_name": "A",
"credential": "M.D.",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2006-07-12",
"last_updated": "2008-09-15",
"status": "A"
},
"taxonomies": [
{
"code": "208000000X",
"taxonomy_group": "",
"desc": "Pediatrics",
"state": "OH",
"license": "35.35075108",
"primary": true
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "2160781",
"state": "OH"
}
],
"endpoints": [],
"other_names": []
}Other providers in Westerville, OH
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 15, 2008; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.