Deverick D Delph, PA-C

Primary specialty

Physician AssistantTaxonomy code 363A00000X

License

PA-1260 Issued in AR

Practice address

1 Childrens Way # 512-17
Little Rock, AR 72202-3500

Phone

(501) 334-1100

Fax

(501) 364-4082

NPI assigned

Aug 27, 2019

Sex

Male

Sole proprietor

No

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 AR

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

Medicare enrollment (NPD)

Enrolled

Credentials

Physician Assistant

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 and National Provider Directory roles.

• Arkansas Childrens Hospital

  dba ACH Physicians Billing Group

  • Pediatrics Physician
  • Little Rock, AR
  • NPI 1598773079
  Medicare reassignment NPD
• University of Arkansas for Medical Sciences

  dba Childrens University Medical Group

  • Pediatrics Physician
  • Little Rock, AR
  • NPI 1346230968
  Medicare reassignment NPD
• Arkansas Childrens Professional Services Organization LLC

  • Pediatrics Physician
  • Little Rock, AR
  • NPI 1629889464
  Medicare reassignment
• University of Arkansas for Medical Sciences

  • Family Medicine Physician
  • El Dorado, AR
  • NPI 1023795051
  NPD
• Arkansas Childrens Hospital

  • Dental Clinic/Center
  • Little Rock, AR
  • NPI 1770889552
  NPD (past)

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

{
    "created_epoch": "1566864000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1712707200000",
    "number": "1477101152",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1 CHILDRENS WAY # 653",
            "city": "LITTLE ROCK",
            "state": "AR",
            "postal_code": "722023500",
            "telephone_number": "501-364-1100",
            "fax_number": "501-364-4082"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1 CHILDRENS WAY # 512-17",
            "city": "LITTLE ROCK",
            "state": "AR",
            "postal_code": "722023500",
            "telephone_number": "501-334-1100",
            "fax_number": "501-364-4082"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "2150 Herbert Ct",
            "address_purpose": "LOCATION",
            "city": "Greenville",
            "state": "NC",
            "postal_code": "278343736",
            "country_code": "US",
            "telephone_number": "252-744-8285",
            "fax_number": "252-744-3829",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "DELPH",
        "first_name": "DEVERICK",
        "middle_name": "D",
        "credential": "PA-C",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2019-08-27",
        "last_updated": "2024-04-10",
        "certification_date": "2024-04-10",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "NC",
            "license": "0010-09615",
            "primary": false
        },
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "AR",
            "license": "PA-1260",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Joseph Deloach
• Kamlyn Deloach
• Kristina Nicole Deloney, APRN
• Lorenzo Delong
• Rachel Lois Delong, MD
• Delta Wave LLC
• Pedro Demeritte
• Brittany Danielle Deming
• Matthew John Denefe, MD
• Matthew Deneke, MD

• Physician Assistant in Little Rock, AR
• Providers in Little Rock, AR by specialty
• Physician Assistant in Arkansas

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 10, 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.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.