Derek Russell Stout, DO

Primary specialty

Anesthesiology PhysicianTaxonomy code 207L00000X

License

2022-01044 Issued in NC

Practice address

810 Fairgrove Church Rd
Hickory, NC 28602-9617

Phone

(855) 968-8233

Fax

(866) 502-1008

NPI assigned

Apr 20, 2016

Last updated

May 22, 2023By the provider in NPPES

Sex

Male

Sole proprietor

Yes

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 NC, UT2 enrollments

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 2

Specialty

Anesthesiology

Education

Western Un of HLTH Sciences, Col of Podiatric Med, 2018

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

Mountain West Anesthesia LLCGroup PAC ID 9032018502, 267 clinicians

Practice addresses (Care Compare)

Hospital & facility affiliations

• Intermountain Health Alta View Hospital Hospital, Sandy, UT, CCN 460044

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Osteopathy

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, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

• Mountain West Anesthesia LLC

  • Anesthesiology Physician
  • Lehi, UT
  • NPI 1558391763
  Medicare reassignment Care Compare group NPD
• Providence Anesthesiology Associates, P.a.

  • Anesthesiology Physician
  • Charlotte, NC
  • NPI 1396739884
  Medicare reassignment NPD
• Western Piedmont Anesthesia PA

  • Anesthesiology Physician
  • Hickory, NC
  • NPI 1134172604
  Medicare reassignment NPD
• Mary Hitchcock Memorial Hospital

  • General Acute Care Hospital
  • Lebanon, NH
  • NPI 1023092053
  NPD

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

• Ihc Health Services Inc

  dba Intermountain Health Alta View Hospital

  • General Acute Care Hospital
  • Sandy, UT
  • NPI 1962412486
  Care Compare affiliation

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

{
    "created_epoch": "1461110400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1684713600000",
    "number": "1336593839",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 488",
            "city": "CONOVER",
            "state": "NC",
            "postal_code": "286130488",
            "telephone_number": "855-968-8233",
            "fax_number": "866-502-1008"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "810 FAIRGROVE CHURCH RD",
            "city": "HICKORY",
            "state": "NC",
            "postal_code": "286029617",
            "telephone_number": "855-968-8233",
            "fax_number": "866-502-1008"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "1 Medical Center Dr",
            "address_purpose": "LOCATION",
            "city": "Lebanon",
            "state": "NH",
            "postal_code": "037560001",
            "country_code": "US",
            "telephone_number": "603-650-5000",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "STOUT",
        "first_name": "DEREK",
        "middle_name": "RUSSELL",
        "credential": "DO",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2016-04-20",
        "last_updated": "2023-05-22",
        "certification_date": "2023-05-22",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207L00000X",
            "taxonomy_group": "",
            "desc": "Anesthesiology",
            "state": "NH",
            "license": "21104",
            "primary": false
        },
        {
            "code": "207L00000X",
            "taxonomy_group": "",
            "desc": "Anesthesiology",
            "state": "NC",
            "license": "2022-01044",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Dallas La Toi Stokes, BCBA
• Angela S Stone, OTR L
• Sean Stone
• Lydia Golladay Stonerook
• Madison M Story, MS, CCC-SLP
• William Frank Straka, DDS
• Holly Strauss, LCMHC
• Lindsi Street
• Brooke Day Strickland, PA
• Susan A Strickland, CNSD

• Anesthesiology Physician in Hickory, NC
• Providers in Hickory, NC by specialty
• Anesthesiology Physician in North Carolina

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 22, 2023; 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.