James Alan Derrisaw, M.D.

Primary specialty

Anesthesiology PhysicianTaxonomy code 207L00000X

License

DR.0039525 Issued in CO

Practice address

1236 E Elizabeth St
Suite 1
Fort Collins, CO 80524-4000

Phone

(970) 224-2985

Fax

(970) 472-9381

NPI assigned

Oct 6, 2005

Last updated

Jun 6, 2013By 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 4

Addresses

Other identifiers 2

Medicare fee-for-service enrollment

Enrolled in WY, CO2 enrollments

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 2

Specialty

Interventional Pain ManagementAlso: Anesthesiology

Education

University of Colorado School of Medicine, Denver, 1997

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

Northern Colorado Anesthesia Professionals PLLCGroup PAC ID 6800878760, 155 clinicians

Ncap Imh LLCGroup PAC ID 2365833340, 10 clinicians

Practice addresses (Care Compare)

Hospital & facility affiliations

• Ivinson Memorial Hospital Hospital, Laramie, WY, CCN 530025

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Medicine

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.

• Ncap Imh, LLC

  • Anesthesiology Physician
  • Fort Collins, CO
  • NPI 1093478075

  WY

  Medicare reassignment Care Compare group NPD
• Northern Colorado Anesthesia Professionals PLLC

  • Anesthesiology Physician
  • Fort Collins, CO
  • NPI 1851389613
  Medicare reassignment Care Compare group
• Matthews-Vu Medical Group, P.C.

  • Internal Medicine Physician
  • Colorado Springs, CO
  • NPI 1649438433
  NPD (past)
• Lincare Inc.

  • Durable Medical Equipment & Medical Supplies
  • Sacramento, CA
  • NPI 1134167760
  NPD (past)

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

• Ivinson Memorial Hospital

  • Rural Acute Care Hospital
  • Laramie, WY
  • NPI 1336289552
  Care Compare affiliation

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

{
    "created_epoch": "1128556800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1370476800000",
    "number": "1710975586",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1236 E ELIZABETH ST",
            "address_2": "SUITE 1",
            "city": "FORT COLLINS",
            "state": "CO",
            "postal_code": "805244000",
            "telephone_number": "970-224-2985",
            "fax_number": "970-472-9381"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1236 E ELIZABETH ST",
            "address_2": "SUITE 1",
            "city": "FORT COLLINS",
            "state": "CO",
            "postal_code": "805244000",
            "telephone_number": "970-224-2985",
            "fax_number": "970-472-9381"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "DERRISAW",
        "first_name": "JAMES",
        "middle_name": "ALAN",
        "name_prefix": "Dr.",
        "credential": "M.D.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2005-10-06",
        "last_updated": "2013-06-06",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207L00000X",
            "taxonomy_group": "",
            "desc": "Anesthesiology",
            "state": "CO",
            "license": "DR.0039525",
            "primary": true
        },
        {
            "code": "207L00000X",
            "taxonomy_group": "",
            "desc": "Anesthesiology",
            "state": "NE",
            "license": "26018",
            "primary": false
        },
        {
            "code": "207L00000X",
            "taxonomy_group": "",
            "desc": "Anesthesiology",
            "state": "WY",
            "license": "6553A",
            "primary": false
        },
        {
            "code": "208VP0014X",
            "taxonomy_group": "",
            "desc": "Pain Medicine, Interventional Pain Medicine",
            "state": "CO",
            "license": "39525",
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "119537900",
            "state": "WY"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "04051262",
            "state": "CO"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Michael A. Deringer, M.D.
• Peggy Ann Derloshon, DDS
• Dermatology & Laser Center of Fort Collins LLC
• Dermatology of Northern Colorado P.C.
• Claire Derr
• Julie Ann Derry
• Carly Derstine
• Andrew Michael Desantis
• Cynthia Schmid Desantis, M.S.W, LCSW, LCSW-C
• Kimberly Desantis, MT-BC

• Anesthesiology Physician in Fort Collins, CO
• Providers in Fort Collins, CO by specialty
• Anesthesiology Physician in Colorado

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 6, 2013; 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.