Patricia Ann Derusso, C.R.N.P.

Primary specialty

Pediatric Gastroenterology PhysicianTaxonomy code 2080P0206X

License

MD048053L Issued in PA

Practice address

3401 Civic Center Blvd
Children'S Hospital of Phila - Gastro & Nutrition
Philadelphia, PA 19104-4319

Phone

(215) 590-3247

Fax

(215) 590-3606

NPI assigned

Jun 17, 2006

Sex

Male

Sole proprietor

No

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 2

Addresses

Other identifiers 1

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Medicine

State licenses

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

{
    "created_epoch": "1150502400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1365984000000",
    "number": "1386689131",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "100 E PENN SQ",
            "address_2": "9TH FLOOR",
            "city": "PHILADELPHIA",
            "state": "PA",
            "postal_code": "191073323",
            "telephone_number": "267-425-9234",
            "fax_number": "267-425-9299"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3401 CIVIC CENTER BLVD",
            "address_2": "CHILDREN'S HOSPITAL OF PHILA - GASTRO & NUTRITION",
            "city": "PHILADELPHIA",
            "state": "PA",
            "postal_code": "191044319",
            "telephone_number": "215-590-3247",
            "fax_number": "215-590-3606"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "DERUSSO",
        "first_name": "PATRICIA",
        "middle_name": "ANN",
        "credential": "C.R.N.P.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-06-17",
        "last_updated": "2013-04-15",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "208000000X",
            "taxonomy_group": "",
            "desc": "Pediatrics",
            "state": "MD",
            "license": "R114248",
            "primary": false
        },
        {
            "code": "2080P0206X",
            "taxonomy_group": "",
            "desc": "Pediatrics, Pediatric Gastroenterology",
            "state": "PA",
            "license": "MD048053L",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "510050000",
            "state": "MD"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• William Derrick Jr., FNP-C
• Krystina Derrickson, CPM
• Pier Derrickson, L.AC
• Holly Derubeis
• Gregory Louis Derusso, M.D.
• Peggy Anne Derusso, CRNP
• Migena Brati Dervishi
• Ajit Desai, MD
• Anagha Kishor Desai, M.D
• Anushka Desai

• Pediatric Gastroenterology Physician in Philadelphia, PA
• Providers in Philadelphia, PA by specialty
• Pediatric Gastroenterology Physician in Pennsylvania

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 15, 2013; 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.