NPIMap

Individual provider Active NPI

James F Derk, D.P.M.

  • Foot & Ankle Surgery Podiatrist
  • Crest Hill, IL
National Provider Identifier
1578645313
Registry record updated Sep 1, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
Foot & Ankle Surgery PodiatristTaxonomy code 213ES0103X
License
016-004278 Issued in IL
Practice address
1640 Willow Circle Dr Unit 200
Crest Hill, IL 60403-0960
Phone
(815) 729-0681
Fax
(815) 729-1374
NPI assigned
Oct 20, 2006
Sex
Male
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Sep 1, 2020

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Foot & Ankle Surgery Podiatrist 213ES0103X 016-004278 IL Primary

Addresses

Primary practice location

1640 Willow Circle Dr Unit 200
Crest Hill, IL 60403-0960

Mailing address

950 N Kennedy Dr
Kankakee, IL 60901-2237
Phone (815) 933-1220

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in IL
Eligible to order & refer
  • Part B services
  • Medical equipment
  • Home health
  • Power mobility devices
  • Hospice
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20071109000612 IL Practitioner - Podiatry 0345338265 Reassigns benefits to 2 organizations
Practice locations: Crest Hill, IL

Care Compare profile

Medicare Care Compare
Specialty
Podiatry
Education
Other, 1988
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Gibson Community Hospital AssociationGroup PAC ID 5092703124, 159 clinicians

Practice addresses (Care Compare)

1 Doctors Park
Gibson City, IL 60936-2000
Phone (217) 784-4297

1120 N Melvin St
Gibson City, IL 60936-1477

227 N Market St
Paxton, IL 60957-1123
Phone (217) 379-4864

3 Doctors Park
Gibson City, IL 60936-2000
Phone (217) 784-4030

4 Doctors Park
Gibson City, IL 60936-2000
Phone (217) 784-4251

7 Doctors Park
Gibson City, IL 60936-2000
Phone (217) 784-5500

Hospital & facility affiliations

  • Gibson Community Hospital Hospital, Gibson City, IL, CCN 141317

Procedures performed for Medicare patients

ProcedureNumber of procedures
Removal of nail tissue141
Removal or shaving of skin growth1-10

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
016-004278ILMDFoot & Ankle Surgery Podiatrist

Practice roles

OrganizationSpecialtyStatusNew patients
Gibson Community Hospital Association Current Accepting new patients
Gibson Community Hospital Association CurrentSince Apr 1, 2015 Accepting new patients
Gibson Community Hospital Association CurrentSince Apr 1, 2015 Accepting new patients

Locations

7 Doctors Park
Gibson City, IL 60936
Phone (217) 784-5500

1120 N Melvin St
Gibson City, IL 60936
Phone (217) 355-1684

912 W Seminary Ave
Onarga, IL 60955
Phone (815) 268-4840

227 N Market St
Paxton, IL 60957
Phone (217) 379-4864

Interoperability endpoints

  • Direct secure messaging: james.derk.p5@direct.gapho.nextgenshare.com
  • Direct secure messaging: james.derk.p26@direct.gapho.nextgenshare.com
  • Direct secure messaging: james.derk.p6@direct.gapho.nextgenshare.com

Organizations & group practices 3

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.

Hospital & facility affiliations 23

Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.

View all 23

NPI Registry JSON

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

{
    "created_epoch": "1161302400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1598918400000",
    "number": "1578645313",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "950 N KENNEDY DR",
            "city": "KANKAKEE",
            "state": "IL",
            "postal_code": "609012237",
            "telephone_number": "815-933-1220",
            "fax_number": "815-463-1864"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1640 WILLOW CIRCLE DR UNIT 200",
            "city": "CREST HILL",
            "state": "IL",
            "postal_code": "604030960",
            "telephone_number": "815-729-0681",
            "fax_number": "815-729-1374"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "DERK",
        "first_name": "JAMES",
        "middle_name": "F",
        "name_prefix": "Dr.",
        "credential": "D.P.M.",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2006-10-20",
        "last_updated": "2020-09-01",
        "certification_date": "2020-09-01",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "213ES0103X",
            "taxonomy_group": "",
            "desc": "Podiatrist, Foot & Ankle Surgery",
            "state": "IL",
            "license": "016-004278",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Crest Hill, IL

Sources for this page

Verify at the official NPI Registry.