Dereck G Campbell, PA-C

Primary specialty

Physician AssistantTaxonomy code 363A00000X

License

2271 Issued in TN

Practice address

222 Oak St
Mountain City, TN 37683-1526

Phone

(423) 727-6319

Fax

(423) 727-4164

NPI assigned

Feb 26, 2013

Last updated

Feb 26, 2013By 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

Medicare fee-for-service enrollment

Enrolled in TN, TX2 enrollments

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 2

Medicare enrollment (NPD)

Enrolled

Credentials

Physician Assistant

State licenses

Practice roles

Locations

Interoperability endpoints

• Direct secure messaging: dereckcampbell@arhs.allscriptsdirect.net

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.

• Fast Pace Medical Clinic PLLC

  • Family Medicine Physician
  • Spring Hill, TN
  • NPI 1134452865
  Medicare reassignment NPD
• Ipc Pac Healthcare Services of Tennessee PC

  • Internal Medicine Physician
  • Bristol, TN
  • NPI 1104277656

  Physician Assistant

  Medicare reassignment NPD
• CS Pacs 3 Southeast, LLC

  • Hospitalist Physician
  • Bluefield, WV
  • NPI 1154104958

  TN

  Medicare reassignment NPD
• NV Pacs 2 LLC

  • Hospitalist Physician
  • Las Vegas, NV
  • NPI 1427534809

  TN

  Medicare reassignment NPD
• Pine Ridge Indian Health Service Hospital

  dba Pine Ridge IHS Hospital

  • General Acute Care Hospital
  • Pine Ridge, SD
  • NPI 1497786412

  TX

  Medicare reassignment NPD
• Fast Pace Medical Clinic PLLC

  • Rural Health Clinic/Center
  • Chapel Hill, TN
  • NPI 1316602774
  NPD
• Pine Ridge Indian Health Service Hospital

  dba LaCreek District Clinic

  • Clinic/Center
  • Martin, SD
  • NPI 1003208257
  NPD

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

{
    "created_epoch": "1361836800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1361836800000",
    "number": "1588904650",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 850",
            "city": "ROGERSVILLE",
            "state": "TN",
            "postal_code": "378570850",
            "telephone_number": "423-727-6319",
            "fax_number": "423-727-4164"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "222 OAK ST",
            "city": "MOUNTAIN CITY",
            "state": "TN",
            "postal_code": "376831526",
            "telephone_number": "423-727-6319",
            "fax_number": "423-727-4164"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "CAMPBELL",
        "first_name": "DERECK",
        "middle_name": "G",
        "name_prefix": "Mr.",
        "credential": "PA-C",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2013-02-26",
        "last_updated": "2013-02-26",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "TN",
            "license": "2271",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Brightside ABA Inc
• Devon Brown, R.N.
• Alric Wesley Burleson, DC
• Judith Burnham, RN
• Nicholas C Bush Jr., BA
• Millie Campbell, RN
• Sarah W Campbell
• Connected Chiropractic and Wellness
• Marisa Gwaltney Cornell, BS
• County of Johnson Superintendent of Schools

• Physician Assistant in Mountain City, TN
• Providers in Mountain City, TN by specialty
• Physician Assistant in Tennessee

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 26, 2013; 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.