Active NPI
Michelle Leigh King Deramus, PH.D.
- Psychologist
- Auburn, AL
National Provider Identifier
1497057400
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Psychologist
- License
- 1648
- Practice address
- 861 N Dean Rd
Suite D
Auburn, AL 36830-9420 - Phone
- (334) 887-4343
- Fax
- (334) 887-5656
- NPI assigned
- Nov 23, 2010
- Sex
- Female
- 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 |
|---|---|---|---|---|
| Psychologist | 103T00000X | 1648 | AL | Primary |
Addresses
Primary practice location
861 N Dean Rd
Suite D
Auburn, AL 36830-9420
Mailing address
861 N Dean Rd
Suite D
Auburn, AL 36830-9420
Phone (334) 887-4343
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1648 | Other | AL | STATE LICENSE |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
- Eligible to order & refer
- Part B services: Yes
- Medical equipment: Yes
- Home health: No
- Power mobility devices: No
- Hospice: No
- Opted out of Medicare
- Yes, effective Oct 1, 2019 through Oct 1, 2027
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
- Credentials
- Doctor of Philosophy
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 1648 | AL | MD | Psychologist |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Auburn Psychology Group, LLC | Psychologist | Past | Accepting new patients |
Interoperability endpoints
- michelle.deramus@pccrm.eclinicaldirectplus.com
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 and National Provider Directory roles.
-
- Psychologist
- Auburn, AL
- NPI 1083980676
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1290470400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1480636800000",
"number": "1497057400",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "861 N DEAN RD",
"address_2": "SUITE D",
"city": "AUBURN",
"state": "AL",
"postal_code": "368309420",
"telephone_number": "334-887-4343",
"fax_number": "334-887-5656"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "861 N DEAN RD",
"address_2": "SUITE D",
"city": "AUBURN",
"state": "AL",
"postal_code": "368309420",
"telephone_number": "334-887-4343",
"fax_number": "334-887-5656"
}
],
"practiceLocations": [],
"basic": {
"last_name": "DERAMUS",
"first_name": "MICHELLE",
"middle_name": "LEIGH KING",
"credential": "PH.D.",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2010-11-23",
"last_updated": "2016-12-02",
"status": "A"
},
"taxonomies": [
{
"code": "103T00000X",
"taxonomy_group": "",
"desc": "Psychologist",
"state": "AL",
"license": "1648",
"primary": true
}
],
"identifiers": [
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "STATE LICENSE",
"identifier": "1648",
"state": "AL"
}
],
"endpoints": [],
"other_names": []
}Other providers in Auburn, AL
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 2, 2016; 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; Opt Out Affidavits.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.