Active NPI
Derek C Archer, M.D.
- Body Imaging Physician
- Lake Barrington, IL
National Provider Identifier
1629164256
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Body Imaging Physician
- License
- 36084401
- Practice address
- 22N285 Pepper Rd
Suite #103
Lake Barrington, IL 60010-5982 - Phone
- (847) 732-2739
- NPI assigned
- Oct 4, 2006
- Sex
- Male
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Body Imaging Physician | 2085B0100X | 36084401 | IL | Primary |
Addresses
Primary practice location
22N285 Pepper Rd
Suite #103
Lake Barrington, IL 60010-5982
Mailing address
410 Rosemary Rd
Toronto, ONTARIO M5P 3E5
CA
Phone (416) 617-0102
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 036-084401#1 | Medicaid | IL |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
- Credentials
- Doctor of Medicine
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Lakeland Radiologists LTD | Past | Accepting new patients | |
| F.a. Wrestler M.D., LTD | Past | Accepting new patients |
Organizations & group practices 2
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.
-
- Health Maintenance Organization
- Champaign, IL
- NPI 1740497833
-
- Diagnostic Radiology Physician
- Charleston, IL
- NPI 1891782090
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1159920000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1221696000000",
"number": "1629164256",
"addresses": [
{
"country_code": "CA",
"country_name": "Canada",
"address_purpose": "MAILING",
"address_type": "FGN",
"address_1": "410 ROSEMARY RD",
"city": "TORONTO",
"state": "ONTARIO",
"postal_code": "M5P 3E5",
"telephone_number": "416-617-0102"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "22N285 PEPPER RD",
"address_2": "SUITE #103",
"city": "LAKE BARRINGTON",
"state": "IL",
"postal_code": "600105982",
"telephone_number": "847-732-2739"
}
],
"practiceLocations": [],
"basic": {
"last_name": "ARCHER",
"first_name": "DEREK",
"middle_name": "C",
"name_prefix": "Dr.",
"credential": "M.D.",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2006-10-04",
"last_updated": "2008-09-18",
"status": "A"
},
"taxonomies": [
{
"code": "2085B0100X",
"taxonomy_group": "",
"desc": "Radiology, Body Imaging",
"state": "IL",
"license": "36084401",
"primary": true
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "036-084401#1",
"state": "IL"
}
],
"endpoints": [],
"other_names": []
}Other providers in Lake Barrington, IL
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 18, 2008; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.