NPIMap

Individual provider Active NPI

Angela Marie Deridder, M.D.

  • Hematology & Oncology Physician
  • Williamsburg, VA
National Provider Identifier
1629377809
Registry record updated Nov 29, 2022
On this page

Key facts

NPPES NPI Registry
Primary specialty
Hematology & Oncology PhysicianTaxonomy code 207RH0003X
License
D83099 Issued in MD
Practice address
120 Kings Way Ste 3100
Williamsburg, VA 23185-2506
Phone
(757) 345-2236
NPI assigned
Mar 27, 2011
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Nov 29, 2022

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Hematology & Oncology Physician 207RH0003X D83099 MD Primary

Addresses

Primary practice location

120 Kings Way Ste 3100
Williamsburg, VA 23185-2506

Mailing address

120 Kings Way
Williamsburg, VA 23185-2505

Other practice location 1

11101 Cathage Rd Ste 2
Berlin, MD 21811-2129
Phone (410) 641-9962

Other practice location 2

100 E Carroll St
Salisbury, MD 21801
Phone (410) 749-1282

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in MD, VA2 enrollments
Eligible to order & refer
  • Part B services
  • Medical equipment
  • Home health
  • Power mobility devices
  • Hospice
Green means eligible to order or refer.

Enrollment records 2

Enrollment IDStateProvider typePAC IDDetails
I20170911000994 MD Practitioner - Hematology/Oncology 9032409255 Reassigns benefits to 2 organizations
I20221115000132 VA Practitioner - Hematology/Oncology 9032409255 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Hematology/Oncology
Education
Other, 2011
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Telehealth
Offers telehealth services
Group practices
Peninsula Cancer Institute, LLCGroup PAC ID 8729031638, 30 clinicians

Practice addresses (Care Compare)

120 Kings Way
Suite 3100
Williamsburg, VA 23185-2506
Phone (757) 345-5724

Hospital & facility affiliations

Merit-based Incentive Payment System (MIPS)

Final score
94.91 of 100Reported as apm
Quality
92.86
Promoting interoperability
94.93
Improvement activities
40

National Provider Directory

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

Practice roles

OrganizationSpecialtyStatusNew patients
Peninsula Cancer Institute LLC Hematology & Oncology CurrentSince Oct 3, 2022 Accepting new patients
Tidalhealth Specialty Care, LLC CurrentSince Sep 1, 2020 Accepting new patients
Tidalhealth Peninsula Regional, Inc. Hematology & Oncology CurrentSince Aug 7, 2017 Accepting new patients
Tidalhealth Peninsula Regional, Inc. CurrentSince Aug 7, 2017 Accepting new patients
Peninsula Cancer Institute LLC Hematology & Oncology Past Accepting new patients

Locations

11105 Cathage Rd
Berlin, MD 21811
Phone (410) 641-9962

100 E Carroll St
Salisbury, MD 21801
Phone (410) 543-7100

145 E Carroll St
Salisbury, MD 21801
Phone (410) 546-6400

106 Milford St
Ste 201
Salisbury, MD 21804
Phone (410) 543-1616

856 J Clyde Morris Blvd
Ste A
Newport News, VA 23601
Phone (757) 316-5900

120 Kings Way
Ste 3100
Williamsburg, VA 23185
Phone (757) 345-5724

Interoperability endpoints

  • Direct secure messaging: aderidder188715@direct.rivhs.com

Organizations & group practices 5

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.

Hospital & facility affiliations 6

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

NPI Registry JSON

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

{
    "created_epoch": "1301184000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1669680000000",
    "number": "1629377809",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "120 KINGS WAY",
            "city": "WILLIAMSBURG",
            "state": "VA",
            "postal_code": "231852505"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "120 KINGS WAY STE 3100",
            "city": "WILLIAMSBURG",
            "state": "VA",
            "postal_code": "231852506",
            "telephone_number": "757-345-2236"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "11101 Cathage Rd Ste 2",
            "address_purpose": "LOCATION",
            "city": "Berlin",
            "state": "MD",
            "postal_code": "218112129",
            "country_code": "US",
            "telephone_number": "410-641-9962",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "100 E Carroll St",
            "address_purpose": "LOCATION",
            "city": "Salisbury",
            "state": "MD",
            "postal_code": "21801",
            "country_code": "US",
            "telephone_number": "410-749-1282",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "DERIDDER",
        "first_name": "ANGELA",
        "middle_name": "MARIE",
        "name_prefix": "Ms.",
        "credential": "M.D.",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2011-03-27",
        "last_updated": "2022-11-29",
        "certification_date": "2022-11-25",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207RH0003X",
            "taxonomy_group": "",
            "desc": "Internal Medicine, Hematology & Oncology",
            "state": "MD",
            "license": "D83099",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Williamsburg, VA

Sources for this page

Verify at the official NPI Registry.