Matthew Derrick, MD

Primary specialty

Neonatal-Perinatal Medicine PhysicianTaxonomy code 2080N0001X

License

036087810 Issued in IL

Practice address

2650 Ridge Ave.
Division of Neonatology, Walgreen BLDG RM 1505
Evanston, IL 60201-1718

Phone

(847) 570-2033

Fax

(847) 570-0231

NPI assigned

Oct 19, 2006

Last updated

Mar 31, 2021By the provider in NPPES

Sex

Male

Sole proprietor

No

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

Specialties & licenses 1

Addresses

Electronic endpoints 1

Medicare fee-for-service enrollment

Enrolled in IL

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: Yes
• Power mobility devices: Yes
• Hospice: Yes

Green means eligible to order or refer.

Enrollment records 1

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Medicine

State licenses

Practice roles

Locations

Interoperability endpoints

• Direct secure messaging: mderrick9512@direct.northshore.org

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.

• Endeavor Health Medical Group

  dba NorthShore University HealthSystem Faculty Practice Associates

  • Emergency Medicine Physician
  • Evanston, IL
  • NPI 1497701882
  Medicare reassignment NPD
• Swedish Covenant Management Services, Inc.

  dba Swedish Covenant Medical Group

  • Obstetrics & Gynecology Physician
  • Chicago, IL
  • NPI 1760432348
  Medicare reassignment NPD
• Endeavor Health Medical Group

  dba NorthShore Anesthesia Group

  • Anesthesiology Physician
  • Evanston, IL
  • NPI 1265695944
  NPD
• Swedish Covenant Management Services, Inc

  dba Swedish Emergency Medicine

  • Emergency Medicine Physician
  • Chicago, IL
  • NPI 1962049551
  NPD
• Swedish Covenant Management Services, Inc.

  dba Anesthesiologists of Swedish Covenant

  • Anesthesiology Physician
  • Chicago, IL
  • NPI 1699126383
  NPD

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

{
    "created_epoch": "1161216000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1617148800000",
    "number": "1568544658",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2650 RIDGE AVE.",
            "address_2": "DIVISION OF NEONATOLOGY, WALGREEN BLDG RM 1505",
            "city": "EVANSTON",
            "state": "IL",
            "postal_code": "602011718",
            "telephone_number": "847-570-2033",
            "fax_number": "847-570-0231"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2650 RIDGE AVE.",
            "address_2": "DIVISION OF NEONATOLOGY, WALGREEN BLDG RM 1505",
            "city": "EVANSTON",
            "state": "IL",
            "postal_code": "602011718",
            "telephone_number": "847-570-2033",
            "fax_number": "847-570-0231"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "DERRICK",
        "first_name": "MATTHEW",
        "name_prefix": "Dr.",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-10-19",
        "last_updated": "2021-03-31",
        "certification_date": "2021-03-31",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "2080N0001X",
            "taxonomy_group": "",
            "desc": "Pediatrics, Neonatal-Perinatal Medicine",
            "state": "IL",
            "license": "036087810",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "mderrick9512@direct.northshore.org",
            "affiliation": "N",
            "address_1": "2650 Ridge Ave.",
            "address_2": "Division of Neonatology, Walgreen Bldg Rm 1505",
            "city": "Evanston",
            "state": "IL",
            "country_code": "US",
            "postal_code": "602011718",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

• Courtney Elizabeth Depa, RDN
• Virginia M Depaul
• Allison Honart West Depersia, MD
• Gregory Derk, DPM
• Miriam Tamara Derman, RN, LAC
• Jessica Desa
• Shiv D Desai, DO
• Mark A Deshur, M.D.
• Brielle Desimone, LMFT
• Noelle Desir, MEDICAL STUDENT

• Neonatal-Perinatal Medicine Physician in Evanston, IL
• Providers in Evanston, IL by specialty
• Neonatal-Perinatal Medicine Physician in Illinois

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 31, 2021; 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.