Active NPI
Roger Deruiter, BS
- Community Health Worker
- West Palm Beach, FL
National Provider Identifier
1366772873
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Community Health Worker
- License
- 13961
- Practice address
- 89 Westwood Cir E
West Palm Beach, FL 33411-4432 - Phone
- (917) 250-0070
- NPI assigned
- Jan 5, 2010
- Last updated
- Jan 5, 2010
- Sex
- Male
- Sole proprietor
- Yes
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 |
|---|---|---|---|---|
| Community Health Worker | 172V00000X | 13961 | FL | Primary |
Addresses
Primary practice location
89 Westwood Cir E
West Palm Beach, FL 33411-4432
Mailing address
89 Westwood Cir E
West Palm Beach, FL 33411-4432
Phone (917) 250-0070
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
- Bachelor of Science
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 13961 | FL | MD | Physical Therapy Assistant |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1262649600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1262649600000",
"number": "1366772873",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "89 WESTWOOD CIR E",
"city": "WEST PALM BEACH",
"state": "FL",
"postal_code": "334114432",
"telephone_number": "917-250-0070"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "89 WESTWOOD CIR E",
"city": "WEST PALM BEACH",
"state": "FL",
"postal_code": "334114432",
"telephone_number": "917-250-0070"
}
],
"practiceLocations": [],
"basic": {
"last_name": "DERUITER",
"first_name": "ROGER",
"name_prefix": "Mr.",
"credential": "BS",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2010-01-05",
"last_updated": "2010-01-05",
"status": "A"
},
"taxonomies": [
{
"code": "172V00000X",
"taxonomy_group": "",
"desc": "Community Health Worker",
"state": "FL",
"license": "13961",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in West Palm Beach, FL
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 5, 2010; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.