Individual provider Active NPI

Anna Lisa Derrien, M.D.

  • Psychiatry Physician
  • New York, NY
National Provider Identifier
1720407414
Registry record updated Jul 1, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
Psychiatry PhysicianTaxonomy code 2084P0800X
License
283898 Issued in NY
Practice address
111 E 77TH St
New York, NY 10075-1802
Phone
(212) 434-2888
NPI assigned
Apr 10, 2014
Last updated
Jul 1, 2020By the provider in NPPES
Sex
Female
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Jul 1, 2020

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Psychiatry Physician 2084P0800X 61172 CT
Psychiatry Physician 2084P0800X 283898 NY Primary

Addresses

Primary practice location

111 E 77TH St
New York, NY 10075-1802

Mailing address

111 E 77TH St
New York, NY 10075-1802
Phone (212) 434-2888

Other practice location 1

317 E 17th St
9th Floor
New York, NY 10003-3804
Phone (212) 420-2390

Other practice location 2

789 Howard Avenue
Fitkin 615
New Haven, CT 06519
Phone (203) 785-2618

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in NY
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

Enrollment IDStateProvider typePAC IDDetails
I20200713002430 NY Practitioner - Psychiatry 1456685437 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Psychiatry
Education
Other, 2014
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
North Shore-Lij Medical PCGroup PAC ID 3375701568, 6,374 clinicians

Practice addresses (Care Compare)

100 E 77TH St
New York, NY 10075-1850
Phone (212) 434-2140

Hospital & facility affiliations

Merit-based Incentive Payment System (MIPS)

Final score
93.07 of 100Reported as apm
Quality
79.77
Promoting interoperability
88.77
Improvement activities
40

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Doctor of Medicine

Practice roles

OrganizationSpecialtyStatusNew patients
North Shore-Lij Medical PC Multi-Specialty CurrentSince Mar 1, 2020 Accepting new patients
North Shore - Lij Medical PC Multi-Specialty CurrentSince Mar 1, 2020 Accepting new patients

Locations

20 York St
North Haven, CT 06510
Phone (203) 688-2433

300 Community Dr
Manhasset, NY 11030

100 E 77th St
New York, NY 10075
Phone (212) 434-2606

111 E 77th St
New York, NY 10075
Phone (212) 434-2810

972 Brush Hollow Rd
Westbury, NY 11590

Networks

  • Healthfirst Medicare Network H5989
  • Healthfirst Medicare Network H1722
  • Healthfirst Medicare Network H9678
  • Healthfirst Medicare Network H3359

Interoperability endpoints

  • Direct secure messaging: aderrien68186@northwell.direct-ci.com

Organizations & group practices 2

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.

Hospital & facility affiliations 1

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

NPI Registry JSON

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

{
    "created_epoch": "1397088000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1593561600000",
    "number": "1720407414",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "111 E 77TH ST",
            "city": "NEW YORK",
            "state": "NY",
            "postal_code": "100751802",
            "telephone_number": "212-434-2888"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "111 E 77TH ST",
            "city": "NEW YORK",
            "state": "NY",
            "postal_code": "100751802",
            "telephone_number": "212-434-2888"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "317 E 17th St",
            "address_2": "9th Floor",
            "address_purpose": "LOCATION",
            "city": "New York",
            "state": "NY",
            "postal_code": "100033804",
            "country_code": "US",
            "telephone_number": "212-420-2390",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "789 Howard Avenue",
            "address_2": "Fitkin 615",
            "address_purpose": "LOCATION",
            "city": "New Haven",
            "state": "CT",
            "postal_code": "06519",
            "country_code": "US",
            "telephone_number": "203-785-2618",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "DERRIEN",
        "first_name": "ANNA LISA",
        "name_prefix": "Dr.",
        "credential": "M.D.",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2014-04-10",
        "last_updated": "2020-07-01",
        "certification_date": "2020-07-01",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "2084P0800X",
            "taxonomy_group": "",
            "desc": "Psychiatry & Neurology, Psychiatry",
            "state": "CT",
            "license": "61172",
            "primary": false
        },
        {
            "code": "2084P0800X",
            "taxonomy_group": "",
            "desc": "Psychiatry & Neurology, Psychiatry",
            "state": "NY",
            "license": "283898",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in New York, NY

Sources for this page

Verify at the official NPI Registry.