Mary Joy E Derla

Primary specialty

Family Nurse PractitionerTaxonomy code 363LF0000X

License

200103 Issued in ND

Practice address

3883 74TH Avenue NE
Fort Totten, ND 58335

Phone

(701) 766-1600

NPI assigned

Aug 6, 2024

Last updated

Aug 6, 2024By the provider in NPPES

Sex

Female

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 TX

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

Other, 2024

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

Spirit Lake TribeGroup PAC ID 2466550801, 22 clinicians

Practice addresses (Care Compare)

Medicare enrollment (NPD)

Enrolled

Credentials

Nurse Practitioner

Practice roles

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

• Spirit Lake Tribe

  dba Spirit Lake Health Center

  • Health Service Clinic/Center
  • Fort Totten, ND
  • NPI 1114472891

  TX

  Medicare reassignment Care Compare group NPD

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

{
    "created_epoch": "1722902400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1722902400000",
    "number": "1407686231",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1401 3RD ST NE APT E",
            "city": "DEVILS LAKE",
            "state": "ND",
            "postal_code": "583013323",
            "telephone_number": "701-350-2409"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3883 74TH AVENUE NE",
            "city": "FORT TOTTEN",
            "state": "ND",
            "postal_code": "58335",
            "telephone_number": "701-766-1600"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "DERLA",
        "first_name": "MARY JOY",
        "middle_name": "E",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2024-08-06",
        "last_updated": "2024-08-06",
        "certification_date": "2024-07-30",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LF0000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Family",
            "state": "ND",
            "license": "200103",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Kenda Cohen, LCSW
• Angela I Cross, LPN
• Nancy C Dauphinais, MLT
• Kyla Sarah Delorme
• Shaylynn F Demarrias, ASW
• Georgalene Dubois
• Linda F Duckwitz, LICSW, LAC
• Emmarae Jean Dunn
• Morrissa Rose Dunn
• Helen Marie Early, FNP

• Family Nurse Practitioner in Fort Totten, ND
• Providers in Fort Totten, ND by specialty
• Family Nurse Practitioner in North Dakota

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 6, 2024; 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.