Derek Storck, FNP-BC

Primary specialty

Primary Care Nurse PractitionerTaxonomy code 363LP2300X

License

209016175 Issued in IL

Practice address

42348 Malbeck Dr
Sterling Heights, MI 48314-3043

Phone

(618) 910-0465

NPI assigned

Jan 27, 2017

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 IL

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

Nurse Practitioner

Education

Saint Louis University School of Medicine, 2016

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

County of ClayGroup PAC ID 0042101982, 77 clinicians

Practice addresses (Care Compare)

Hospital & facility affiliations

• Clay Home Health Services Home health agency, Flora, IL, CCN 147086
• Clay County Hospital Hospital, Flora, IL, CCN 141351
• St Anthonys Memorial Hospital Hospital, Effingham, IL, CCN 140032

Medicare enrollment (NPD)

Enrolled

Credentials

Nurse Practitioner

State licenses

Practice roles

Locations

Interoperability endpoints

• Direct secure messaging: dstorck370738@direct-ehr-ssmhc.com

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.

• County of Clay

  • Rural Health Clinic/Center
  • Flora, IL
  • NPI 1811946411

  Single Specialty

  Medicare reassignment Care Compare group NPD
• County of Clay

  • Critical Access Hospital
  • Flora, IL
  • NPI 1184655136

  Single Specialty

  NPD
• County of Clay

  • Community/Retail Pharmacy
  • Flora, IL
  • NPI 1235990276
  NPD
• County of Clay

  • Rural Health Clinic/Center
  • Clay City, IL
  • NPI 1871950550
  NPD (past)

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

• Clay County Health Department

  • Home Health Agency
  • Flora, IL
  • NPI 1083799035
  Care Compare affiliation
• County of Clay

  • Critical Access Hospital
  • Flora, IL
  • NPI 1184655136
  Care Compare affiliation
• St Anthonys Memorial Hospital of the Hospital Sisters of the Third

  • General Acute Care Hospital
  • Effingham, IL
  • NPI 1306800602
  Care Compare affiliation
• St Anthonys Memorial Hospital of the Hospital Sisters of the Third

  • Clinic/Center
  • Effingham, IL
  • NPI 1881214104

  Hospital

  Care Compare affiliation

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

{
    "created_epoch": "1485475200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1574812800000",
    "number": "1396282448",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "929 STACEY BURK DR",
            "city": "FLORA",
            "state": "IL",
            "postal_code": "628393241",
            "telephone_number": "618-910-0465"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "42348 MALBECK DR",
            "city": "STERLING HEIGHTS",
            "state": "MI",
            "postal_code": "483143043",
            "telephone_number": "618-910-0465"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "STORCK",
        "first_name": "DEREK",
        "name_prefix": "Mr.",
        "credential": "FNP-BC",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2017-01-27",
        "last_updated": "2019-11-27",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LF0000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Family",
            "state": "MI",
            "license": "4704322025",
            "primary": false
        },
        {
            "code": "363LP2300X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Nurse Practitioner, Primary Care",
            "state": "IL",
            "license": "209016175",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Steven D Trombly MD PC
• Steven J. Repitor
• Lynne A Stillwell, MA, LPC
• Stuart Ronald Stoller, D.O.
• Richard A Stone, MD
• Jovonnie Storey
• Jewell Storm
• Catrina Street
• Strive Orthotics & Prosthetics, LLC
• Ronald Joseph Strobel, LLMSW

• Primary Care Nurse Practitioner in Sterling Heights, MI
• Providers in Sterling Heights, MI by specialty
• Primary Care Nurse Practitioner in Michigan

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 27, 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.