Active NPI
Derrick McIntyre
- Addiction (Substance Use Disorder) Counselor
- Pasadena, CA
National Provider Identifier
1447625421
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Addiction (Substance Use Disorder) Counselor
- License
- C20711214
- Practice address
- 1680 N Fair Oaks Ave
Pasadena, CA 91103-1642 - Phone
- (626) 798-0884
- Fax
- (626) 798-6870
- NPI assigned
- Dec 2, 2015
- Last updated
- Dec 2, 2015
- Sex
- Male
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Addiction (Substance Use Disorder) Counselor | 101YA0400X | C20711214 | CA | Primary |
Addresses
Primary practice location
1680 N Fair Oaks Ave
Pasadena, CA 91103-1642
Mailing address
1680 N Fair Oaks Ave
Pasadena, CA 91103-1642
Phone (626) 798-0884
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)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| C20711214 | CA | MD | Addiction (Substance Use Disorder) Counselor |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Los Angeles County Department of Public Health | Current | Accepting new patients |
Interoperability endpoints
- derrickmcintyre-impact@lacsapc.netsmartdirect.net
Organizations & group practices 1
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.
-
- Public Health or Welfare Agency
- Alhambra, CA
- NPI 1700090834
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1449014400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1449014400000",
"number": "1447625421",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "1680 N FAIR OAKS AVE",
"city": "PASADENA",
"state": "CA",
"postal_code": "911031642",
"telephone_number": "626-798-0884",
"fax_number": "626-798-6870"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1680 N FAIR OAKS AVE",
"city": "PASADENA",
"state": "CA",
"postal_code": "911031642",
"telephone_number": "626-798-0884",
"fax_number": "626-798-6870"
}
],
"practiceLocations": [],
"basic": {
"last_name": "MCINTYRE",
"first_name": "DERRICK",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2015-12-02",
"last_updated": "2015-12-02",
"status": "A"
},
"taxonomies": [
{
"code": "101YA0400X",
"taxonomy_group": "",
"desc": "Counselor, Addiction (Substance Use Disorder)",
"state": "CA",
"license": "C20711214",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Pasadena, CA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 2, 2015; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.