Derek Glenn Bazemore Jr., MD

Primary specialty

Family Medicine PhysicianTaxonomy code 207Q00000X

License

ME107380 Issued in FL

Practice address

12750 SW 128TH St Ste 108
Miami, FL 33186-5380

Phone

(917) 750-5709

NPI assigned

Apr 8, 2010

Last updated

Jun 14, 2023By 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 3

Addresses

Other identifiers 1

Medicare fee-for-service enrollment

Enrolled in FL

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

Specialty

Emergency Medicine

Education

New York University School of Medicine, 2005

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

Paragon Contracting Services LLCGroup PAC ID 3971417825, 404 clinicians

Practice addresses (Care Compare)

Hospital & facility affiliations

• North Shore Medical Center Hospital, Miami, FL, CCN 100029

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Medicine

State licenses

Practice roles

Locations

Interoperability endpoints

• Direct secure messaging: wghdbazemo@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.

• Paragon Contracting Services LLC

  • Emergency Medicine Physician
  • Birmingham, AL
  • NPI 1225071459

  FL

  Medicare reassignment Care Compare group NPD
• M&V San Jose Medical Center LLC

  • Family Medicine Physician
  • Miami, FL
  • NPI 1598318495
  Medicare reassignment NPD
• Derek Bazemore MD Inc

  • General Practice Physician
  • Miami, FL
  • NPI 1487344875
  Authorized official Same address or phone
• Emergency Physician Solutions of South Florida, LLC

  • Emergency Medicine Physician
  • Atlantis, FL
  • NPI 1609298181
  NPD (past)

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

• Hsa NSMC LLC

  dba Florida Medical Center

  • General Acute Care Hospital
  • Lauderdale Lakes, FL
  • NPI 1184440828
  Care Compare affiliation
• Hsa NSMC LLC

  dba North Shore Medical Center

  • General Acute Care Hospital
  • Miami, FL
  • NPI 1194552141
  Care Compare affiliation

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

{
    "created_epoch": "1270684800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1686700800000",
    "number": "1639495245",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "55 SW 9TH ST APT 1405",
            "city": "MIAMI",
            "state": "FL",
            "postal_code": "331303992",
            "telephone_number": "917-750-5709"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "12750 SW 128TH ST STE 108",
            "city": "MIAMI",
            "state": "FL",
            "postal_code": "331865380",
            "telephone_number": "917-750-5709"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "BAZEMORE",
        "first_name": "DEREK",
        "middle_name": "GLENN",
        "name_prefix": "Dr.",
        "name_suffix": "Jr.",
        "credential": "MD",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2010-04-08",
        "last_updated": "2023-06-14",
        "certification_date": "2023-06-14",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207P00000X",
            "taxonomy_group": "",
            "desc": "Emergency Medicine",
            "state": "FL",
            "license": "ME107380",
            "primary": false
        },
        {
            "code": "208D00000X",
            "taxonomy_group": "",
            "desc": "General Practice",
            "state": "FL",
            "license": "ME107380",
            "primary": false
        },
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "FL",
            "license": "ME107380",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "002509700",
            "state": "FL"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Demarko Victor Bazan, CRNA
• Nesla Z Bazan
• Suzette Beatriz Bazan, MS
• Roxana Bazart Correa
• Joanna Bazart
• Manouska Bazil
• Nancy Emmanuella Bazile-Francois
• Lissa Fabienne Bazile
• Pierre-Laurent Bazin, APRN
• Andrea Bazo

• Family Medicine Physician in Miami, FL
• Providers in Miami, FL by specialty
• Family Medicine Physician in Florida

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 14, 2023; 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.