Theresa M Derickson, MD

Primary specialty

Pediatrics PhysicianTaxonomy code 208000000X

License

35088598 Issued in OH

Practice address

8040 Princeton-Glendale Rd.
West Chester, OH 45069-0000

Phone

(513) 872-2000

Fax

(513) 281-8842

NPI assigned

Sep 28, 2006

Last updated

Oct 2, 2014By the provider in NPPES

Sex

Female

Sole proprietor

No

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

Specialties & licenses 1

Addresses

Other identifiers 1

Medicare fee-for-service enrollment

Enrolled in OH

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: Yes
• Power mobility devices: Yes
• Hospice: Yes

Green means eligible to order or refer.

Enrollment records 1

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Medicine

State licenses

Practice roles

Locations

Interoperability endpoints

• Direct secure messaging: tdericksonmd377@direct.trihealth.com

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.

• Trihealth G LLC

  • Internal Medicine Physician
  • Cincinnati, OH
  • NPI 1295862944

  Pediatrics

  Medicare reassignment NPD
• Trihealth G, LLC

  dba GE Family Wellness Center Pharmacy

  • Community/Retail Pharmacy
  • Cincinnati, OH
  • NPI 1184023640
  NPD
• Trihealth G LLC

  dba Group Health

  • Internal Medicine Physician
  • Cincinnati, OH
  • NPI 1336242726

  Pediatrics

  NPD (past)

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

{
    "created_epoch": "1159401600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1412208000000",
    "number": "1639260169",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4685 FOREST AVE STE C",
            "city": "CINCINNATI",
            "state": "OH",
            "postal_code": "452123359",
            "telephone_number": "513-246-7796",
            "fax_number": "513-852-8525"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "8040 PRINCETON-GLENDALE RD.",
            "city": "WEST CHESTER",
            "state": "OH",
            "postal_code": "450690000",
            "telephone_number": "513-872-2000",
            "fax_number": "513-281-8842"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "DERICKSON",
        "first_name": "THERESA",
        "middle_name": "M",
        "name_prefix": "Dr.",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2006-09-28",
        "last_updated": "2014-10-02",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "208000000X",
            "taxonomy_group": "",
            "desc": "Pediatrics",
            "state": "OH",
            "license": "35088598",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "2704836",
            "state": "OH"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Abigail Patricia Denny
• Dental Associates of West Chester, LLC
• Dental Specialties of West Chester
• Dentistry at University Pointe
• Kathryn Noel Depp, CCC-SLP
• Dermatology & Skin Care Associates
• Courtney Destifanes
• Kyle Edward Detavernier, DDS
• Anne Deters, P.T
• Richard Deutch, O.D.

• Pediatrics Physician in West Chester, OH
• Providers in West Chester, OH by specialty
• Pediatrics Physician in Ohio

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 2, 2014; 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.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.