Samone L. Derks, LMSW

Primary specialty

Clinical Social WorkerTaxonomy code 1041C0700X

License

6801102088 Issued in MI

Practice address

129 W Baraga Ave Ste F
Marquette, MI 49855-4761

Phone

(906) 361-1386

Fax

(906) 273-1650

NPI assigned

Jan 17, 2018

Last updated

Oct 22, 2020By the provider in NPPES

Sex

Female

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 MI

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: No
• Power mobility devices: No
• Hospice: No

Green means eligible to order or refer.

Enrollment records 1

Specialty

Clinical Social Worker

Education

Other, 2014

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Practice addresses (Care Compare)

Medicare enrollment (NPD)

Enrolled

State licenses

Practice roles

Locations

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.

• Samone Derks LLC

  • Community/Behavioral Health Agency
  • Marquette, MI
  • NPI 1215542733
  Medicare reassignment NPD Authorized official

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

{
    "created_epoch": "1516147200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1603324800000",
    "number": "1447768056",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "129 W BARAGA AVE STE F",
            "city": "MARQUETTE",
            "state": "MI",
            "postal_code": "498554761",
            "telephone_number": "906-361-1386",
            "fax_number": "906-273-1650"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "129 W BARAGA AVE STE F",
            "city": "MARQUETTE",
            "state": "MI",
            "postal_code": "498554761",
            "telephone_number": "906-361-1386",
            "fax_number": "906-273-1650"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "DERKS",
        "first_name": "SAMONE",
        "middle_name": "L.",
        "credential": "LMSW",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2018-01-17",
        "last_updated": "2020-10-22",
        "certification_date": "2020-10-22",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1041C0700X",
            "taxonomy_group": "",
            "desc": "Social Worker, Clinical",
            "state": "WA",
            "license": "LW60781970",
            "primary": false
        },
        {
            "code": "1041C0700X",
            "taxonomy_group": "",
            "desc": "Social Worker, Clinical",
            "state": "MI",
            "license": "6801102088",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Dennis a. Herzog, M.D.,P.C
• Kayla Marie Dennis, LLMSW
• Dental Associates of Marquette PLLP
• Emily Elizabeth Depetro, PSYD
• Kristen A Deprey, PT
• Daniel Deroche
• Allison Marie Derouin
• Ed Deyo
• Prakash R Dhadphale, M.D.
• Natalie F Dhamers, CRNA

• Clinical Social Worker in Marquette, MI
• Providers in Marquette, MI by specialty
• Clinical Social Worker in Michigan

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 22, 2020; 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.