NPIMap

Individual provider Active NPI

Timothy Hans Derstine, M.D.

  • Psychiatry Physician
  • State College, PA
National Provider Identifier
1629076534
Registry record updated Jul 26, 2016
On this page

Key facts

NPPES NPI Registry
Primary specialty
Psychiatry PhysicianTaxonomy code 2084P0800X
License
MD 056013-L Issued in PA
Practice address
315 S Allen St
Suite 216
State College, PA 16801-4849
Phone
(814) 689-9744
Fax
(888) 981-8069
NPI assigned
Jul 13, 2005
Last updated
Jul 26, 2016By the provider in NPPES
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jul 26, 2016

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Psychiatry Physician 2084P0800X MD 056013-L PA Primary

Addresses

Primary practice location

315 S Allen St
Suite 216
State College, PA 16801-4849

Mailing address

PO Box 1120
Lemont, PA 16851-1120
Phone (814) 689-9744

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in PA
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
I20100819000458 PA Practitioner - Psychiatry 2466355813 Reassigns benefits to 2 organizations

Care Compare profile

Medicare Care Compare
Specialty
Psychiatry
Education
Temple University School of Medicine, 1992
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Telehealth
Offers telehealth services

Practice addresses (Care Compare)

315 S Allen St
Suite 216
State College, PA 16801-4850
Phone (814) 206-7776

Hospital & facility affiliations

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Doctor of Medicine

State licenses

LicenseStateTypeSpecialty
MD 056013-LPAMDPsychiatry Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Cen Clear Child Services, Inc. CurrentSince May 14, 2020 Accepting new patients
Mount Nittany Medical Center Past Accepting new patients
Community Services Group, Inc. PastSince Oct 1, 2002 Accepting new patients

Locations

50 Bigler Rd
Woodland, PA 16881

Organizations & group practices 4

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.

Hospital & facility affiliations 26

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

View all 26

NPI Registry JSON

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

{
    "created_epoch": "1121212800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1469491200000",
    "number": "1629076534",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 1120",
            "city": "LEMONT",
            "state": "PA",
            "postal_code": "168511120",
            "telephone_number": "814-689-9744"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "315 S ALLEN ST",
            "address_2": "SUITE 216",
            "city": "STATE COLLEGE",
            "state": "PA",
            "postal_code": "168014849",
            "telephone_number": "814-689-9744",
            "fax_number": "888-981-8069"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "DERSTINE",
        "first_name": "TIMOTHY",
        "middle_name": "HANS",
        "name_prefix": "Dr.",
        "credential": "M.D.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2005-07-13",
        "last_updated": "2016-07-26",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "2084P0800X",
            "taxonomy_group": "",
            "desc": "Psychiatry & Neurology, Psychiatry",
            "state": "PA",
            "license": "MD 056013-L",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in State College, PA

Sources for this page

Verify at the official NPI Registry.