Derek Booth

Primary specialty

Psychiatric/Mental Health Nurse PractitionerTaxonomy code 363LP0808X

License

71005314B Issued in IN

Practice address

415 N 26TH St
Suite 201
Lafayette, IN 47904-2895

Phone

(765) 446-6577

NPI assigned

Jan 24, 2015

Last updated

Jan 24, 2015By the provider in NPPES

Sex

Male

Sole proprietor

Yes

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

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Enrolled in IN

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

Nurse Practitioner

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, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

• Bloomington Meadows GP

  • Family Nurse Practitioner
  • Bloomington, IN
  • NPI 1033298120
  Medicare reassignment NPD
• State of Indiana, Auditor of State

  dba Madison State Hospital

  • Psychiatric Hospital
  • Madison, IN
  • NPI 1700876224
  Medicare reassignment NPD
• Valley Oaks Health Inc

  • Mental Health Clinic/Center (Including Community Mental Health Center)
  • Lafayette, IN
  • NPI 1689629990
  Medicare reassignment
• State of Indiana, Auditor of State

  dba Indiana Department of Health

  • Public Health or Welfare Agency
  • Indianapolis, IN
  • NPI 1023613403
  NPD
• State of Indiana, Auditor of State

  dba NeuroDiagnostic Institute

  • Psychiatric Hospital
  • Indianapolis, IN
  • NPI 1043338684
  NPD

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

{
    "created_epoch": "1422057600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1422057600000",
    "number": "1568852986",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "415 N 26TH ST",
            "address_2": "SUITE 201",
            "city": "LAFAYETTE",
            "state": "IN",
            "postal_code": "479042895"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "415 N 26TH ST",
            "address_2": "SUITE 201",
            "city": "LAFAYETTE",
            "state": "IN",
            "postal_code": "479042895",
            "telephone_number": "765-446-6577"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "BOOTH",
        "first_name": "DEREK",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2015-01-24",
        "last_updated": "2015-01-24",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LP0808X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Psychiatric/Mental Health",
            "state": "IN",
            "license": "71005314B",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Michael Bolton Jr.
• Katherine L Bolyard, PH.D.
• Shelley F Boniello, LMHC
• Kathryn Rebecca Bontrager, PA-C
• Florence Bonus
• Kara M Booth, RD
• Laura Ann Booth, LCAC
• David Heine Bos, MD, PHD
• Roger Bosley, M.D.
• Emily G Bosso

• Psychiatric/Mental Health Nurse Practitioner in Lafayette, IN
• Providers in Lafayette, IN by specialty
• Psychiatric/Mental Health Nurse Practitioner in Indiana

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 24, 2015; 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.