Individual provider Active NPI

Derek Lanier, MD MPH

  • Family Medicine Physician
  • Rockford, MI
National Provider Identifier
1417139130
Registry record updated Dec 15, 2014
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Medicine PhysicianTaxonomy code 207Q00000X
License
4301057270 Issued in MI
Practice address
8450 Brower Lake Rd NE
Apt/Suite
Rockford, MI 49341-9346
Phone
(616) 874-1577
Fax
(616) 874-1577
NPI assigned
Dec 4, 2007
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Dec 15, 2014

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Family Medicine Physician 207Q00000X 4301057270 MI Primary

Addresses

Primary practice location

8450 Brower Lake Rd NE
Apt/Suite
Rockford, MI 49341-9346

Mailing address

366 W 8TH St Apt 52
San Pedro, CA 90731-3730
Phone (248) 842-4421

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Not listed in the public Medicare enrollment file

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Doctor of Medicine

State licenses

LicenseStateTypeSpecialty
131628CAMDClinical Social Worker
4301057270MIMDFamily Medicine Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Prospect Foothill Urgent Care Current Accepting new patients
Metropolitan Ipa Family Medicine Current Accepting new patients
Care@Home Solutions Ca Inc Family Medicine Current Accepting new patients
Bronson Methodist Hospital Past Accepting new patients
Ascension Borgess Hospital Past Accepting new patients

Organizations & group practices 5

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.

NPI Registry JSON

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

{
    "created_epoch": "1196726400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1418601600000",
    "number": "1417139130",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "366 W 8TH ST APT 52",
            "city": "SAN PEDRO",
            "state": "CA",
            "postal_code": "907313730",
            "telephone_number": "248-842-4421"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "8450 BROWER LAKE RD NE",
            "address_2": "APT/SUITE",
            "city": "ROCKFORD",
            "state": "MI",
            "postal_code": "493419346",
            "telephone_number": "616-874-1577",
            "fax_number": "616-874-1577"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "LANIER",
        "first_name": "DEREK",
        "name_prefix": "Dr.",
        "credential": "MD MPH",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2007-12-04",
        "last_updated": "2014-12-15",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "MI",
            "license": "4301057270",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Rockford, MI

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 15, 2014; 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.