NPIMap

Organization Active NPI

Dera Health LLC

  • Psychiatry Physician
  • Phoenix, AZ
National Provider Identifier
1407500812
Registry record updated Feb 5, 2022
On this page

Key facts

NPPES NPI Registry
Primary specialty
Psychiatry PhysicianTaxonomy code 2084P0800X
Legal business name
DERA HEALTH LLC
Practice address
10 W Minnezona Ave
Phoenix, AZ 85013-4933
Phone
(206) 816-4594
NPI assigned
Feb 5, 2022
Last updated
Feb 5, 2022By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Feb 5, 2022

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

Authorized official

Name
Benita Martin, DNPNPI 1346613049
Title
DNP
Phone
(206) 816-4594

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Family Medicine PhysicianGroup: 193400000X MULTIPLE SINGLE SPECIALTY GROUP 207Q00000X
Psychiatry PhysicianGroup: 193400000X MULTIPLE SINGLE SPECIALTY GROUP 2084P0800X Primary

Addresses

Primary practice location

10 W Minnezona Ave
Phoenix, AZ 85013-4933

Mailing address

10 W Minnezona Ave
Phoenix, AZ 85013-4933

Electronic endpoints 1

TypeEndpointUseAffiliation
Other URL Website Direct

National Provider Directory

National Provider Directory

Practitioners & affiliated clinicians

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

NPI Registry JSON

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

{
    "created_epoch": "1644019200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1644019200000",
    "number": "1407500812",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "10 W MINNEZONA AVE",
            "city": "PHOENIX",
            "state": "AZ",
            "postal_code": "850134933"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "10 W MINNEZONA AVE",
            "city": "PHOENIX",
            "state": "AZ",
            "postal_code": "850134933",
            "telephone_number": "206-816-4594"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "DERA HEALTH LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2022-02-05",
        "last_updated": "2022-02-05",
        "certification_date": "2022-02-05",
        "status": "A",
        "authorized_official_last_name": "MARTIN",
        "authorized_official_first_name": "BENITA",
        "authorized_official_title_or_position": "DNP",
        "authorized_official_telephone_number": "206-816-4594",
        "authorized_official_credential": "DNP"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "193400000X MULTIPLE SINGLE SPECIALTY GROUP",
            "desc": "Family Medicine",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "2084P0800X",
            "taxonomy_group": "193400000X MULTIPLE SINGLE SPECIALTY GROUP",
            "desc": "Psychiatry & Neurology, Psychiatry",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [
        {
            "endpointType": "OTHERS",
            "endpointTypeDescription": "Other URL",
            "endpoint": "Website",
            "affiliation": "N",
            "use": "DIRECT",
            "useDescription": "Direct",
            "contentType": "CSV",
            "contentTypeDescription": "CSV",
            "address_1": "10 W Minnezona Ave",
            "city": "Phoenix",
            "state": "AZ",
            "country_code": "US",
            "postal_code": "850134933",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

Other providers in Phoenix, AZ

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 5, 2022; 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.