Todd Michael Derreberry, M.D.

Primary specialty

Psychiatry PhysicianTaxonomy code 2084P0800X

License

2015-00894 Issued in NC

Practice address

2554 Lewisville Clemmons Rd Ste 207
Clemmons, NC 27012-9752

Phone

(336) 223-8220

Fax

(339) 207-0143

NPI assigned

Jun 18, 2009

Sex

Male

Sole proprietor

No

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

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Medicine

State licenses

Practice roles

Locations

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.

• Envision Behavioral Health PLLC

  • Psychiatry Physician
  • Clemmons, NC
  • NPI 1689165508

  Psychiatry

  NPD

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

{
    "created_epoch": "1245283200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1591747200000",
    "number": "1295962066",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2554 LEWISVILLE CLEMMONS RD STE 207",
            "city": "CLEMMONS",
            "state": "NC",
            "postal_code": "270129752",
            "telephone_number": "336-223-8220",
            "fax_number": "339-207-0143"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2554 LEWISVILLE CLEMMONS RD STE 207",
            "city": "CLEMMONS",
            "state": "NC",
            "postal_code": "270129752",
            "telephone_number": "336-223-8220",
            "fax_number": "339-207-0143"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "DERREBERRY",
        "first_name": "TODD",
        "middle_name": "MICHAEL",
        "name_prefix": "Dr.",
        "credential": "M.D.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2009-06-18",
        "last_updated": "2020-06-10",
        "certification_date": "2020-06-10",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "2084P0805X",
            "taxonomy_group": "",
            "desc": "Psychiatry & Neurology, Geriatric Psychiatry",
            "state": "WV",
            "license": "25736",
            "primary": false
        },
        {
            "code": "2084P0800X",
            "taxonomy_group": "",
            "desc": "Psychiatry & Neurology, Psychiatry",
            "state": "NC",
            "license": "2015-00894",
            "primary": true
        },
        {
            "code": "2084P0800X",
            "taxonomy_group": "",
            "desc": "Psychiatry & Neurology, Psychiatry",
            "state": "WV",
            "license": "25736",
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Terry Michael Deakle, PA
• Joseph A Dealoe, RBT
• Martin Dekkers, DPT
• Lia Deland
• Robert Denig, LPC
• Rebecca Dey, PHARMD
• Rhonda Wallace Dixon, WHNP
• Jeremy Dockery, CADC, SAP, ICAADC,
• Terry Ann Donovan, DPM
• Jodi M Douthit

• All providers in Clemmons, NC
• Psychiatry Physician in North Carolina

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 10, 2020; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.