Derek James Pelletier, PAC

Primary specialty

Physician AssistantTaxonomy code 363A00000X

License

PA03964 Issued in TX

Practice address

2504 Ridge Road
Suite 203
Rockwall, TX 75087

Phone

(214) 771-3100

Fax

(214) 771-3101

NPI assigned

Jul 15, 2006

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

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

HHS exclusion list flag

Flagged The directory lists this NPI on an HHS exclusion list. The OIG exclusions file (LEIE) holds no record for this NPI, and the directory does not say which list the flag comes from. How exclusions are shown Confirm with the OIG exclusions search.

Credentials

Physician Assistant

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

{
    "created_epoch": "1152921600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1183852800000",
    "number": "1730105230",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1553 HWY 34 SOUTH",
            "address_2": "#600",
            "city": "TERRELL",
            "state": "TX",
            "postal_code": "75160",
            "telephone_number": "972-563-8500",
            "fax_number": "972-563-8501"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2504 RIDGE ROAD",
            "address_2": "SUITE 203",
            "city": "ROCKWALL",
            "state": "TX",
            "postal_code": "75087",
            "telephone_number": "214-771-3100",
            "fax_number": "214-771-3101"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "PELLETIER",
        "first_name": "DEREK",
        "middle_name": "JAMES",
        "credential": "PAC",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-07-15",
        "last_updated": "2007-07-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "TX",
            "license": "PA03964",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• Physician Assistant in Rockwall, TX
• Providers in Rockwall, TX by specialty
• Physician Assistant in Texas

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 8, 2007; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.