Active NPI
Derek A Fickenscher, MD
- Emergency Medicine Physician
- Overland Park, KS
National Provider Identifier
1477510030
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Emergency Medicine Physician
- License
- 2002008817
- Practice address
- 6700 College Blvd
Overland Park, KS 66211-1525 - Phone
- (913) 693-7198
- Fax
- (877) 409-3317
- NPI assigned
- Apr 27, 2006
- 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 |
|---|---|---|---|---|
| Emergency Medicine Physician | 207P00000X | 2002008817 | MO | Primary |
Addresses
Primary practice location
6700 College Blvd
Overland Park, KS 66211-1525
Mailing address
6700 College Blvd
Overland Park, KS 66211-1525
Phone (913) 693-7198
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 205876204 | Medicaid | MO |
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
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| QT Quikmed LLC | Past | Accepting new patients | |
| Madison County Memorial Hospital | Past | Accepting new patients |
Organizations & group practices 2
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.
-
- Medicare Defined Swing Bed Hospital Unit
- Winterset, IA
- NPI 1194880112
-
- Family Medicine Physician
- Tulsa, OK
- NPI 1013590074
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1146096000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1694476800000",
"number": "1477510030",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "6700 COLLEGE BLVD",
"city": "OVERLAND PARK",
"state": "KS",
"postal_code": "662111525",
"telephone_number": "913-693-7198",
"fax_number": "913-409-3317"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "6700 COLLEGE BLVD",
"city": "OVERLAND PARK",
"state": "KS",
"postal_code": "662111525",
"telephone_number": "913-693-7198",
"fax_number": "877-409-3317"
}
],
"practiceLocations": [],
"basic": {
"last_name": "FICKENSCHER",
"first_name": "DEREK",
"middle_name": "A",
"credential": "MD",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2006-04-27",
"last_updated": "2023-09-12",
"certification_date": "2023-09-12",
"status": "A"
},
"taxonomies": [
{
"code": "207P00000X",
"taxonomy_group": "",
"desc": "Emergency Medicine",
"state": "MO",
"license": "2002008817",
"primary": true
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "205876204",
"state": "MO"
}
],
"endpoints": [],
"other_names": []
}Other providers in Overland Park, KS
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 12, 2023; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.