James Quincey Derrick, PA – Physician Assistant

Key facts

NPI: 1346471802
Entity type: Individual (NPI type 1)
Primary specialty: Physician Assistant 363A00000X
License: PA2009-0016 (NM)
Practice address: CR 0324 Hwy 84 N #14
Tierra Amarilla, NM 87575
Phone: (575) 588-7252
Fax: (575) 588-9132
NPI assigned: Jul 31, 2009
Sex: Male
Sole proprietor: No

Organizations & group practices 4

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.

Presbyterian Medical Services Federally Qualified Health Center (FQHC) · Rio Rancho, NM · NPI 1871505032

Medicare reassignment NM
La Clinica del Pueblo de Rio Arriba Federally Qualified Health Center (FQHC) · Tierra Amarilla, NM · NPI 1598797805

NPD
Presbyterian Medical Services Community/Retail Pharmacy · Albuquerque, NM · NPI 1306654462

NPD
Presbyterian Medical Services Mental Health Clinic/Center (Including Community Mental Health Center) · Socorro, NM · NPI 1760805303

NPD

Medicare participation

Medicare fee-for-service enrollment: Enrolled in NM
Eligible to order & refer: Part B services: Yes · DME: Yes · Home health: Yes · Power mobility devices: Yes · Hospice: No

Medicare enrollment records

Enrollment ID	State	Provider type	PAC ID	Details
I20100104000491	NM	Practitioner - Physician Assistant	5395886055	Reassigns benefits to 1 organization

National Provider Directory

Medicare enrollment (NPD): Yes
Credentials: Physician Assistant

State licenses

License	State	Type	Specialty
PA2009-0016	NM	MD	Physician Assistant

Practice roles

Organization	Status	New patients
La Clinica del Pueblo de Rio Arriba	Current	Accepting new patients
Presbyterian Medical Services	Current since Nov 2, 2015	Accepting new patients
Presbyterian Medical Services	Current since Nov 2, 2015	Accepting new patients

Locations

1422 Paseo de Peralta
Santa Fe, NM 87501
Phone (505) 982-5565

Specialties & licenses

Specialty (taxonomy)	Code	License	State	Primary
Physician Assistant	363A00000X	PA2009-0016	NM	Yes

Addresses

Primary practice location

CR 0324 Hwy 84 N #14
Tierra Amarilla, NM 87575

Mailing address

PO Box 250
Tierra Amarilla, NM 87575-0250
Phone (575) 588-7252

Other providers in Tierra Amarilla, NM

All providers in Tierra Amarilla, NM · Physician Assistant in New Mexico

Sources for this page

NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Aug 22, 2011. Information in NPPES is self-reported and not verified by CMS.
NUCC Health Care Provider Taxonomy: specialty names.
Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
Order and Referring (CMS).
National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.