Mary K Derlacki, FNP

Primary specialty

Rheumatology PhysicianTaxonomy code 207RR0500X

License

090006104N1 Issued in OR

Practice address

2800 W Overland Rd
Boise, ID 83705-3038

Phone

(208) 801-1414

Fax

(208) 207-2866

NPI assigned

Nov 13, 2006

Sex

Female

Sole proprietor

No

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

Specialties & licenses 2

Addresses

Other identifiers 1

Medicare fee-for-service enrollment

Enrolled in OR, ID2 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

Specialty

Nurse Practitioner

Education

Other, 1989

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

Pioneer Sports and Pain Center LLCGroup PAC ID 8325263379, 6 clinicians

Practice addresses (Care Compare)

Hospital & facility affiliations

• Sacred Heart Medical Center - Riverbend Hospital, Springfield, OR, CCN 380102

Medicare enrollment (NPD)

Enrolled

Credentials

Nurse Practitioner

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 and National Provider Directory roles.

• Healing House PLLC

  • Mental Health Clinic/Center (Including Community Mental Health Center)
  • Boise, ID
  • NPI 1902542343

  ID

  Medicare reassignment NPD
• DRS Cassell & Boren PC

  • Rheumatology Physician
  • Eugene, OR
  • NPI 1316035728

  OR, Rheumatology

  Medicare reassignment NPD
• Pioneer Sports & Pain Center LLC

  • Rehabilitation Chiropractor
  • Kuna, ID
  • NPI 1598068280
  Care Compare group
• Boise Ketamine Clinic

  • Infusion Therapy Clinic/Center
  • Boise, ID
  • NPI 1518547140
  NPD

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

• Peacehealth

  • General Acute Care Hospital
  • Springfield, OR
  • NPI 1083888515

  Hospital

  Care Compare affiliation
• Peacehealth

  • Psychiatric Hospital Unit
  • Eugene, OR
  • NPI 1568236974

  Hospital

  Care Compare affiliation

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

{
    "created_epoch": "1163376000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1729123200000",
    "number": "1609947431",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1707 N 19TH ST",
            "city": "BOISE",
            "state": "ID",
            "postal_code": "837020706",
            "telephone_number": "541-232-6732"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2800 W OVERLAND RD",
            "city": "BOISE",
            "state": "ID",
            "postal_code": "837053038",
            "telephone_number": "208-801-1414",
            "fax_number": "208-207-2866"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "DERLACKI",
        "first_name": "MARY",
        "middle_name": "K",
        "credential": "FNP",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2006-11-13",
        "last_updated": "2024-10-17",
        "certification_date": "2024-10-17",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LF0000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Family",
            "state": "ID",
            "license": "69483",
            "primary": false
        },
        {
            "code": "207RR0500X",
            "taxonomy_group": "",
            "desc": "Internal Medicine, Rheumatology",
            "state": "OR",
            "license": "090006104N1",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "005785",
            "state": "OR"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Dentistry One of Idaho PC
• Dentists of Boise and Orthodontics, PC
• Rebecca Lynn Deppen, RN
• Derek Derkacs, PA-C
• Avalon Noel Taylor Derlacki Prentiss, LPC
• Dermaclinical, Inc.
• Olga Derman, M.D.
• Dermatology Clinic of Idaho
• David Deroin, MD
• Jayne Derr, LCSW

• All providers in Boise, ID
• Rheumatology Physician in Idaho

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 17, 2024; 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.
• 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.