Derick Stackpole

Primary specialty

Physician AssistantTaxonomy code 363A00000X

License

0110006532 Issued in VA

Practice address

4035 Electric Rd Ste a
Roanoke, VA 24018

Phone

(540) 772-8670

NPI assigned

Dec 30, 2018

Sex

Male

Sole proprietor

No

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

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Enrolled in VA

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: Yes
• Power mobility devices: Yes
• Hospice: No

Green means eligible to order or refer.

Enrollment records 1

Specialty

Physician Assistant

Education

Other, 2018

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

Carilion Emergency Services IncGroup PAC ID 7012820889, 67 clinicians

Carilion Healthcare CorporationGroup PAC ID 5890607253, 540 clinicians

Practice addresses (Care Compare)

Medicare enrollment (NPD)

Enrolled

Credentials

Physician Assistant

Practice roles

Locations

Interoperability endpoints

• Direct secure messaging: dstackpole63975@direct.carilionclinic.org

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.

• Carilion Emergency Services, Inc.

  • Urgent Care Clinic/Center
  • Roanoke, VA
  • NPI 1255602694
  Medicare reassignment Care Compare group NPD
• Carilion Healthcare Corporation

  • Multi-Specialty Clinic/Center
  • Roanoke, VA
  • NPI 1447206370
  Medicare reassignment Care Compare group NPD
• Carilion Medical Center

  • Emergency Medicine Physician
  • Roanoke, VA
  • NPI 1649423815
  Medicare reassignment NPD
• Carilion Giles Community Hospital

  • Critical Access Hospital
  • Pearisburg, VA
  • NPI 1194718304
  Medicare reassignment
• Carilion Rockbridge Community Hospital

  • Multi-Specialty Clinic/Center
  • Lexington, VA
  • NPI 1174636021
  Medicare reassignment
• Carilion Giles Community Hospital

  • Rural Health Clinic/Center
  • Rocky Mount, VA
  • NPI 1275151318
  NPD
• Carilion Giles Community Hospital

  • Durable Medical Equipment & Medical Supplies
  • Galax, VA
  • NPI 1639980493
  NPD
• Carilion Healthcare Corporation

  • Durable Medical Equipment & Medical Supplies
  • Blacksburg, VA
  • NPI 1407667256
  NPD
• Carilion Medical Center

  • Durable Medical Equipment & Medical Supplies
  • Hardy, VA
  • NPI 1073324810
  NPD
• Carilion Medical Center

  • Durable Medical Equipment & Medical Supplies
  • Roanoke, VA
  • NPI 1982908547
  NPD
• Carilion Rockbridge Community Hospital

  • Hospitalist Physician
  • Lexington, VA
  • NPI 1023663002
  NPD

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

{
    "created_epoch": "1546128000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1567036800000",
    "number": "1396217485",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4035 ELECTRIC RD STE A",
            "city": "ROANOKE",
            "state": "VA",
            "postal_code": "240188449",
            "telephone_number": "540-772-8670"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4035 ELECTRIC RD STE A",
            "city": "ROANOKE",
            "state": "VA",
            "postal_code": "24018",
            "telephone_number": "540-772-8670"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "1906 Belleview Ave SE",
            "address_purpose": "LOCATION",
            "city": "Roanoke",
            "state": "VA",
            "postal_code": "240141838",
            "country_code": "US",
            "telephone_number": "540-314-9194",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "STACKPOLE",
        "first_name": "DERICK",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2018-12-30",
        "last_updated": "2019-08-29",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "VA",
            "license": "0110006532",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Sutin - Srisumrid, M.D
• Christina St. Clair, PHD
• St. Vincent'S Home, Inc.
• Laura St.Clair, M.A. ED.
• Rosina Zangari Stack
• Holly Stacy, OTR/L
• John M Stadnyk, M.D.
• Amber J Stafford, CPNP-PC
• Karen Michelle Staggs, M.D.
• Pamela Stallings, OCCUPATIONAL THERAPY

• Physician Assistant in Roanoke, VA
• Providers in Roanoke, VA by specialty
• Physician Assistant in Virginia

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 29, 2019; 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.