Jose J Dergan, PSY.D

Primary specialty

Clinical PsychologistTaxonomy code 103TC0700X

License

PY 004206 Issued in FL

Practice address

8249 NW 36TH St Ste 102
Doral, FL 33166-6673

Phone

(305) 599-1970

Fax

(305) 599-1971

NPI assigned

Sep 28, 2006

Last updated

Nov 22, 2010By 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

Other identifiers 2

Medicare fee-for-service enrollment

Enrolled in FL

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: No
• Power mobility devices: No
• Hospice: No

Green means eligible to order or refer.

Enrollment records 1

Specialty

Clinical Psychologist

Education

Other, 1987

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Practice addresses (Care Compare)

Hospital & facility affiliations

• Larkin Community Hospital Palm Springs Campus Hospital, Hialeah, FL, CCN 100050
• Larkin Community Hospital Hospital, South Miami, FL, CCN 100181

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Philosophy

State licenses

Practice roles

Locations

Interoperability endpoints

• Direct secure messaging: wghjderga@yourcarecommunity.org

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.

• Jose J Dergan P. a

  • Psychologist
  • Doral, FL
  • NPI 1063714178
  Medicare reassignment NPD
• Mirta N. Matos Psy.D P.a.

  • Psychiatric Hospital
  • Doral, FL
  • NPI 1437338563
  NPD (past)

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

• Larkin Community Hospital Inc

  • General Acute Care Hospital
  • Miami, FL
  • NPI 1952311243
  Care Compare affiliation
• Larkin Community Hospital Palm Springs Campus, LLC

  • General Acute Care Hospital
  • Hialeah, FL
  • NPI 1013382860
  Care Compare affiliation

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

{
    "created_epoch": "1159401600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1290384000000",
    "number": "1629160817",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "8249 NW 36TH ST STE 102",
            "city": "DORAL",
            "state": "FL",
            "postal_code": "331666673",
            "telephone_number": "305-599-1970",
            "fax_number": "305-599-1971"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "8249 NW 36TH ST STE 102",
            "city": "DORAL",
            "state": "FL",
            "postal_code": "331666673",
            "telephone_number": "305-599-1970",
            "fax_number": "305-599-1971"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "DERGAN",
        "first_name": "JOSE",
        "middle_name": "J",
        "name_prefix": "Dr.",
        "credential": "PSY.D",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2006-09-28",
        "last_updated": "2010-11-22",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "103TC0700X",
            "taxonomy_group": "",
            "desc": "Psychologist, Clinical",
            "state": "FL",
            "license": "PY 004206",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "210099100",
            "state": "FL"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "TAX IDENTIFICATION",
            "identifier": "65-0167578",
            "state": "FL"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Dental Specialist of Doral
• Dental Specialists of Doral Group
• Dentists of Doral West, P.a (Dentists of Doral West)
• Dentists of Doral, PA (Dentists of Doral)
• Gabriela Alejandra Deras, BCBA
• Sandra Deris Atassi, PSY.D.
• Dermatology Group of Florida, P.a.
• Dermatology Network Solutions of Central Florida, LLC
• Dermatology Network Solutions of South Florida II, LLC
• Dermatology Network Solutions of South Florida, LLC

• Clinical Psychologist in Doral, FL
• Providers in Doral, FL by specialty
• Clinical Psychologist in Florida

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 22, 2010; 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.