Active NPI
Derylene Proctor
- Case Manager/Care Coordinator
- Monticello, FL
National Provider Identifier
1710351986
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Case Manager/Care Coordinator
- Practice address
- 5773 N Salt Rd
Monticello, FL 32344-5173 - Phone
- (850) 544-3045
- NPI assigned
- Nov 25, 2015
- Sex
- Female
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 4
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Case Manager/Care Coordinator | 171M00000X | Primary | ||
| Counselor | 101Y00000X | |||
| Addiction (Substance Use Disorder) Counselor | 101YA0400X | |||
| Mental Health Counselor | 101YM0800X | AC# 6530425 | FL |
Addresses
Primary practice location
5773 N Salt Rd
Monticello, FL 32344-5173
Mailing address
5773 N Salt Rd
Monticello, FL 32344-5173
Phone (850) 544-3045
Medicare participation
Medicare enrollment files- 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: No
- Hospice: No
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| AC# 6530425 | FL | MD | Mental Health Counselor |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Angels on Assignment | Past | Accepting new patients |
Organizations & group practices 1
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.
-
- Case Management Agency
- Monticello, FL
- NPI 1619349347
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1448409600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1448409600000",
"number": "1710351986",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "5773 N SALT RD",
"city": "MONTICELLO",
"state": "FL",
"postal_code": "323445173",
"telephone_number": "850-544-3045"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "5773 N SALT RD",
"city": "MONTICELLO",
"state": "FL",
"postal_code": "323445173",
"telephone_number": "850-544-3045"
}
],
"practiceLocations": [],
"basic": {
"last_name": "PROCTOR",
"first_name": "DERYLENE",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2015-11-25",
"last_updated": "2015-11-25",
"status": "A"
},
"taxonomies": [
{
"code": "171M00000X",
"taxonomy_group": "",
"desc": "Case Manager/Care Coordinator",
"state": null,
"license": null,
"primary": true
},
{
"code": "101Y00000X",
"taxonomy_group": "",
"desc": "Counselor",
"state": null,
"license": null,
"primary": false
},
{
"code": "101YA0400X",
"taxonomy_group": "",
"desc": "Counselor, Addiction (Substance Use Disorder)",
"state": null,
"license": null,
"primary": false
},
{
"code": "101YM0800X",
"taxonomy_group": "",
"desc": "Counselor, Mental Health",
"state": "FL",
"license": "AC# 6530425",
"primary": false
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Monticello, FL
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 25, 2015; 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.