Derek Flack, DO

Primary specialty

Family Medicine PhysicianTaxonomy code 207Q00000X

License

DO191255 Issued in OR

Practice address

2841 Avenue G
White City, OR 97503-3024

Phone

(309) 672-4977

NPI assigned

Jun 16, 2016

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

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

Family Practice

Education

Other, 2016

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

University of Florida Jacksonville Physicians, Inc.Group PAC ID 9133025869, shared by 5 NPIs, 908 clinicians

Practice addresses (Care Compare)

Hospital & facility affiliations

• Uf Health Home Care - Jacksonville Home health agency, Jacksonville, FL, CCN 107125
• Shands Jacksonville Hospital, Jacksonville, FL, CCN 100001

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Osteopathy

State licenses

Practice roles

Locations

Interoperability endpoints

• Direct secure messaging: dflack720374@direct.shands.ufl.edu

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.

• University of Florida Jacksonville Physicians Inc

  • Diagnostic Radiology Physician
  • Jacksonville, FL
  • NPI 1326208695
  Medicare reassignment NPD
• University of Florida Jacksonville Physicians Inc

  • Family Medicine Physician
  • Jacksonville, FL
  • NPI 1487814752
  Medicare reassignment NPD
• University of Florida Jacksonville Physicians, Inc.

  • Family Medicine Physician
  • Jacksonville, FL
  • NPI 1235398983
  NPD
• University of Florida Jacksonville Physicians, Inc.

  • Family Medicine Physician
  • Yulee, FL
  • NPI 1518126168
  NPD
• University of Florida Jacksonville Physicians, Inc.

  • Physiological Laboratory
  • Jacksonville, FL
  • NPI 1831800952
  NPD

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

• Shands Jacksonville Medical Center Inc

  • Urgent Care Clinic/Center
  • Jacksonville, FL
  • NPI 1144962408

  Hospital

  Care Compare affiliation
• Shands Jacksonville Medical Center Inc

  • Home Health Agency
  • Jacksonville, FL
  • NPI 1669563557
  Care Compare affiliation
• Shands Jacksonville Medical Center Inc

  • General Acute Care Hospital
  • Jacksonville, FL
  • NPI 1821186313
  Care Compare affiliation

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

{
    "created_epoch": "1466035200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1560988800000",
    "number": "1679923098",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2620 E BARNETT RD STE H",
            "city": "MEDFORD",
            "state": "OR",
            "postal_code": "975048383"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2841 AVENUE G",
            "city": "WHITE CITY",
            "state": "OR",
            "postal_code": "975033024",
            "telephone_number": "309-672-4977"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "FLACK",
        "first_name": "DEREK",
        "credential": "DO",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2016-06-16",
        "last_updated": "2019-06-20",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "OR",
            "license": "DO191255",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Kris Egelston, QMHA, CADC 1-R, CRM
• Karen Elliot, LPCA
• Dereck David Estrada, LPMHC
• Kourtni Faber, RDH
• Jim Figone, R.D.
• Miranda Flowers, LCSW
• Annette Foster
• Adrian Anthony Garibay
• Donald M Garner, LCSW
• Prachi Rana Garodia, MD

• Family Medicine Physician in White City, OR
• Providers in White City, OR by specialty
• Family Medicine Physician in Oregon

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 20, 2019; 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.