Derosset Myers Jr., PHD

Primary specialty

Clinical PsychologistTaxonomy code 103TC0700X

License

431 Issued in SC

Practice address

15 Medical Park Rd
Suite 103
Columbia, SC 29203-8003

Phone

(803) 255-3400

Fax

(803) 255-3420

NPI assigned

Mar 24, 2006

Last updated

Apr 30, 2008By the provider in NPPES

Sex

Male

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 2

Medicare fee-for-service enrollment

Enrolled in SC

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

Telehealth

Offers telehealth services

Group practices

Charleston Counseling Center PCGroup PAC ID 6204125107, 186 clinicians

Practice addresses (Care Compare)

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Philosophy

State licenses

Practice roles

Locations

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.

• Charleston Counseling Center PC

  dba Lifestance Health

  • Mental Health Counselor
  • Mount Pleasant, SC
  • NPI 1316375678
  Medicare reassignment Care Compare group NPD
• Myrtle Beach Counseling Center

  • Mental Health Counselor
  • Myrtle Beach, SC
  • NPI 1235784661
  NPD
• Lake Psychological Services, LLC

  • Clinical Psychologist
  • Columbia, SC
  • NPI 1225061971
  NPD (past)
• University Specialty Clinics - Neuropsychiatry and Behavioral Science

  • Psychiatry Physician
  • Columbia, SC
  • NPI 1821020116
  NPD (past)

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

{
    "created_epoch": "1143158400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1209513600000",
    "number": "1659331460",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "15 MEDICAL PARK RD",
            "address_2": "SUITE 103",
            "city": "COLUMBIA",
            "state": "SC",
            "postal_code": "292038003",
            "telephone_number": "803-255-3400",
            "fax_number": "803-255-3420"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "15 MEDICAL PARK RD",
            "address_2": "SUITE 103",
            "city": "COLUMBIA",
            "state": "SC",
            "postal_code": "292038003",
            "telephone_number": "803-255-3400",
            "fax_number": "803-255-3420"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "MYERS",
        "first_name": "DEROSSET",
        "name_suffix": "Jr.",
        "credential": "PHD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-03-24",
        "last_updated": "2008-04-30",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "103TC0700X",
            "taxonomy_group": "",
            "desc": "Psychologist, Clinical",
            "state": "SC",
            "license": "431",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "PS0046",
            "state": "SC"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "GP0720",
            "state": "SC"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• My Global Destianations LLC (MGD Transports)
• My Magic Hands Therapuetic Massage LTD. Co, LLC (My Magic Hands Therapuetic Massage)
• Abigail Gonzalez Myers
• Bertha Yvette Myers, MA
• Dana Grace Myers, MSN, FNP-C
• Eric Myers, APRN, FNP
• Felicity Costin Myers, PH.D.
• Jacob Myers, RDN
• Jodi Myers, APRN
• Kathy Myers, MSP CCC-SLP

• Clinical Psychologist in Columbia, SC
• Providers in Columbia, SC by specialty
• Clinical Psychologist in South Carolina

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 30, 2008; 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.