Ellen Lyman Thomason Derrick, MD

Primary specialty

Vascular Surgery PhysicianTaxonomy code 2086S0129X

License

MD00045873 Issued in WA

Practice address

3216 NE 45TH PL Ste 207
Seattle, WA 98105-4028

Phone

(206) 596-3976

Fax

(206) 486-9013

NPI assigned

Aug 30, 2006

Last updated

Jul 21, 2022By 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

Other names 1

• Ellen L Thomason Former name

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Eligible to order & refer

• Part B services: No
• Medical equipment: Yes
• Home health: No
• Power mobility devices: Yes
• Hospice: No

Green means eligible to order or refer.

Specialty

Vascular Surgery

Education

Other, 2001

Medicare assignment

May accept Medicare assignment

Practice addresses (Care Compare)

Procedures performed for Medicare patients

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Medicine

State licenses

Practice roles

Locations

Interoperability endpoints

• Direct secure messaging: ellen.derrick.1@15645.direct.athenahealth.com
• FHIR API: https://api.platform.athenahealth.com/15645/brand/1/csg/1/fhir/r4

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.

• Boxbar Consulting PLLC

  dba BoxBar Vascular

  • Vascular Surgery Physician
  • Seattle, WA
  • NPI 1841712072
  Authorized official Same address or phone
• Derrick Consulting PLLC

  • Anesthesiology Physician
  • Seattle, WA
  • NPI 1902335805
  NPD

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

{
    "created_epoch": "1156896000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1658361600000",
    "number": "1659480630",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "6541 50TH AVE NE",
            "city": "SEATTLE",
            "state": "WA",
            "postal_code": "98115",
            "telephone_number": "206-818-6905"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3216 NE 45TH PL STE 207",
            "city": "SEATTLE",
            "state": "WA",
            "postal_code": "981054028",
            "telephone_number": "206-596-3976",
            "fax_number": "206-486-9013"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "DERRICK",
        "first_name": "ELLEN",
        "middle_name": "LYMAN THOMASON",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2006-08-30",
        "last_updated": "2022-07-21",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "2086S0129X",
            "taxonomy_group": "",
            "desc": "Surgery, Vascular Surgery",
            "state": "WA",
            "license": "MD00045873",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1659480630",
            "state": "WA"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "ELLEN",
            "last_name": "THOMASON",
            "middle_name": "L",
            "code": "1",
            "type": "Former Name"
        }
    ]
}

• Jennifer J. Derosa
• Julia Deroshia
• Stephanie Isabelle Julie Derouet
• Antonia Derramas, LMHCA
• Derrick Consulting PLLC
• Peter Derrick
• Susan Parker Derrick, PT
• Nicholas Peter Derrico, MD
• Andrea L. Deruiter, CCC-SLP
• Courtney Ann Deruiter, SLP

• Vascular Surgery Physician in Seattle, WA
• Providers in Seattle, WA by specialty
• Vascular Surgery Physician in Washington

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 21, 2022; 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.