NPIMap

Organization Active NPI

Derick Dermatology, PLLC

  • Dermatology Physician
  • Arlington Heights, IL
National Provider Identifier
1497792618
Registry record updated Jul 12, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Dermatology PhysicianTaxonomy code 207N00000X
Legal business name
DERICK DERMATOLOGY, PLLC
Practice address
85 W Algonquin Road
Suite 220
Arlington Heights, IL 60005
Phone
(847) 381-8899
Fax
(847) 381-8999
NPI assigned
May 31, 2006
Last updated
Jul 12, 2024By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jul 12, 2024

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name
Dr. Amy Jane Derick, M.D.NPI 1245279884
Title
Medical Director
Phone
(847) 381-8899

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 4

Specialty (taxonomy)CodeLicenseStatePrimary
Dermatology PhysicianGroup: 193400000X SINGLE SPECIALTY GROUP 207N00000X 36112935 IL
Dermatology PhysicianGroup: 193200000X MULTI-SPECIALTY GROUP 207N00000X Primary
Dermatopathology (Pathology) PhysicianGroup: 193200000X MULTI-SPECIALTY GROUP 207ZD0900X
Non-Pharmacy Dispensing Site 332900000X

Addresses

Primary practice location

85 W Algonquin Road
Suite 220
Arlington Heights, IL 60005

Mailing address

PO Box 6685
Carol Stream, IL 60197-6685
Phone (847) 381-8899

Other practice location 1

956 Surrey Ln
Northbrook, IL 60062-3733
Phone (847) 381-8899

Other practice location 2

1612 Cabot Ln
Glenview, IL 60026-7751
Phone (847) 381-8899

Other practice location 3

1811 Elmore Ave
Downers Grove, IL 60515-4429
Phone (847) 381-8899

Other practice location 4

6433 N Tahoma Ave
Chicago, IL 60646-2921
Phone (847) 381-8899

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in IL

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20060922000130 IL Part B Supplier - Clinic/Group Practice 1557366796 Receives reassigned benefits from 60 practitioners
18 other NPIs on this enrollment
This NPI is an additional NPI on the enrollment
Practice locations: Plainfield, IL; Arlington Heights, IL; Skokie, IL; Orland Park, IL; Oak Park, IL; Oak Brook, IL; Northbrook, IL; Naperville, IL…

Other NPIs on the same Medicare enrollment 18

NPIs listed together on one Medicare enrollment, typically parts of the same organization.

View all 18

Laboratory certificates & supplier records

Derived by NPIMap

These CMS records do not include an NPI. They are shown because their name and street address match this provider’s.

CLIA laboratory certificates

CLIA numberLaboratoryCertificateExpires
14D2044747Derick Dermatology, LLC85W Algonquin Rd, Suite 220, Arlington Heights, IL 60005ComplianceMay 1, 2027
14D2119893Derick Dermatology, LLC1612 Cabot Lane, Glenview, IL 60026ComplianceFeb 1, 2027
14D2176451Derick Dermatology, L L C1811 Elmore Ave, Downers Grove, IL 60515ComplianceJan 20, 2027
14D2239041Derick Dermatology, LLC956 Surrey Lane, Northbrook, IL 60062ComplianceSep 14, 2027
14D2310145Derick Dermatology, LLC6433 N Tahoma Ave, Chicago, IL 60646ComplianceApr 27, 2027

National Provider Directory

National Provider Directory

Locations

824 W Bartlett Rd
Bartlett, IL 60103
Phone (630) 213-3217

239 Remington Blvd Ste 225
Bolingbrook, IL 60440

225 E Chicago Ave
#268
Chicago, IL 60611

325 E Congress Pkwy Ste 200
Crystal Lake, IL 60014

353 Bank Dr
McHenry, IL 60050

353 Bank Dr
Ste 400
McHenry, IL 60050

263 Shuman Blvd
Naperville, IL 60563
Phone (517) 428-0114

12736 S Route 59
Unit 102
Plainfield, IL 60585

Practitioners & affiliated clinicians

Practitioners 74

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

View all 74

NPI Registry JSON

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

{
    "created_epoch": "1149033600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1720742400000",
    "number": "1497792618",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 6685",
            "city": "CAROL STREAM",
            "state": "IL",
            "postal_code": "601976685",
            "telephone_number": "847-381-8899",
            "fax_number": "847-381-8999"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "85 W ALGONQUIN ROAD",
            "address_2": "SUITE 220",
            "city": "ARLINGTON HEIGHTS",
            "state": "IL",
            "postal_code": "60005",
            "telephone_number": "847-381-8899",
            "fax_number": "847-381-8999"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "956 Surrey Ln",
            "address_purpose": "LOCATION",
            "city": "Northbrook",
            "state": "IL",
            "postal_code": "600623733",
            "country_code": "US",
            "telephone_number": "847-381-8899",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "1612 Cabot Ln",
            "address_purpose": "LOCATION",
            "city": "Glenview",
            "state": "IL",
            "postal_code": "600267751",
            "country_code": "US",
            "telephone_number": "847-381-8899",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "1811 Elmore Ave",
            "address_purpose": "LOCATION",
            "city": "Downers Grove",
            "state": "IL",
            "postal_code": "605154429",
            "country_code": "US",
            "telephone_number": "847-381-8899",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "6433 N Tahoma Ave",
            "address_purpose": "LOCATION",
            "city": "Chicago",
            "state": "IL",
            "postal_code": "606462921",
            "country_code": "US",
            "telephone_number": "847-381-8899",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "organization_name": "DERICK DERMATOLOGY, PLLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-05-31",
        "last_updated": "2024-07-12",
        "certification_date": "2024-07-12",
        "status": "A",
        "authorized_official_last_name": "DERICK",
        "authorized_official_first_name": "AMY",
        "authorized_official_middle_name": "JANE",
        "authorized_official_title_or_position": "MEDICAL DIRECTOR",
        "authorized_official_telephone_number": "847-381-8899",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "M.D."
    },
    "taxonomies": [
        {
            "code": "207N00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Dermatology",
            "state": "IL",
            "license": "36112935",
            "primary": false
        },
        {
            "code": "207N00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Dermatology",
            "state": null,
            "license": null,
            "primary": true
        },
        {
            "code": "207ZD0900X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Pathology, Dermatopathology",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "332900000X",
            "taxonomy_group": "",
            "desc": "Non-Pharmacy Dispensing Site",
            "state": null,
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Arlington Heights, IL

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 12, 2024; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • 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.