Active NPI
John Thomas Derrick II, B.S.
- Counselor
- Rockledge, FL
National Provider Identifier
1730325044
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Counselor
- Practice address
- 1037 Pathfinder Way Ste 130
Rockledge, FL 32955-3242 - Phone
- (321) 639-1224
- NPI assigned
- Dec 17, 2008
- Sex
- Male
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Counselor | 101Y00000X | Primary |
Addresses
Primary practice location
1037 Pathfinder Way Ste 130
Rockledge, FL 32955-3242
Mailing address
1037 Pathfinder Way Ste 130
Rockledge, FL 32955-3242
Phone (321) 639-1224
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
- Credentials
- Bachelor of Science
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Impower, Inc | Counselor | 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.
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1229472000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1229472000000",
"number": "1730325044",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "1037 PATHFINDER WAY STE 130",
"city": "ROCKLEDGE",
"state": "FL",
"postal_code": "329553242",
"telephone_number": "321-639-1224"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1037 PATHFINDER WAY STE 130",
"city": "ROCKLEDGE",
"state": "FL",
"postal_code": "329553242",
"telephone_number": "321-639-1224"
}
],
"practiceLocations": [],
"basic": {
"last_name": "DERRICK",
"first_name": "JOHN",
"middle_name": "THOMAS",
"name_prefix": "Mr.",
"name_suffix": "II",
"credential": "B.S.",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2008-12-17",
"last_updated": "2008-12-17",
"status": "A"
},
"taxonomies": [
{
"code": "101Y00000X",
"taxonomy_group": "",
"desc": "Counselor",
"state": null,
"license": null,
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Rockledge, FL
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 17, 2008; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.