NPIMap

Individual provider Active NPI

Derek Allen Stephenson, M.D.

  • Surgery Physician
  • Vineland, NJ
National Provider Identifier
1740441443
Registry record updated Dec 31, 2019
On this page

Key facts

NPPES NPI Registry
Primary specialty
Surgery PhysicianTaxonomy code 208600000X
License
25MA09618900 Issued in NJ
Practice address
1103 West Sherman Avenue
Building 2 Unit C
Vineland, NJ 08360
Phone
(856) 362-5259
Fax
(856) 405-6978
NPI assigned
Jun 24, 2008
Last updated
Dec 31, 2019By the provider in NPPES
Sex
Male
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Dec 31, 2019

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

Specialties & licenses 3

Specialty (taxonomy)CodeLicenseStatePrimary
Student in an Organized Health Care Education/Training Program 390200000X ME116873 FL
Surgery Physician 208600000X R70529 AZ
Surgery Physician 208600000X 25MA09618900 NJ Primary

Addresses

Primary practice location

1103 West Sherman Avenue
Building 2 Unit C
Vineland, NJ 08360

Mailing address

1103 West Sherman Avenue
Building 2 Unit C
Vineland, NJ 08360
Phone (856) 362-5259

Other identifiers 1

IdentifierTypeStateIssuer
0475025MedicaidNJ

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in NJ
Eligible to order & refer
  • Part B services
  • Medical equipment
  • Home health
  • Power mobility devices
  • Hospice
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20150330000476 NJ Practitioner - General Surgery 3173766292 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
General Surgery
Education
Morehouse School of Medicine, 2008
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Esa South Jersey Bariatrics, P.a.Group PAC ID 1759560600, 3 clinicians

Practice addresses (Care Compare)

1103 W Sherman Ave
Building 2 Unit C
Vineland, NJ 08360-6912
Phone (856) 362-5259

Hospital & facility affiliations

Procedures performed for Medicare patients

ProcedureNumber of procedures
Colonoscopy1-10
Hernia repair (minimally invasive)13
Upper gastrointestinal (GI) endoscopy for acid reflux13
Removal of tissue20
Skin biopsy1-10

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
R70529AZMDSurgery Physician
25MA09618900NJMDSurgery Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Esa South Jersey Bariatrics, P.a. Surgery CurrentSince Mar 1, 2015 Accepting new patients

Locations

1103 W Sherman Ave
Ste 2C
Vineland, NJ 08360
Phone (856) 362-5259

2950 College Dr
Ste 1B
Vineland, NJ 08360
Phone (856) 691-7588

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, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

Hospital & facility affiliations 8

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": "1214265600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1577750400000",
    "number": "1740441443",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1103 WEST SHERMAN AVENUE",
            "address_2": "BUILDING 2 UNIT C",
            "city": "VINELAND",
            "state": "NJ",
            "postal_code": "08360",
            "telephone_number": "856-362-5259",
            "fax_number": "856-405-6978"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1103 WEST SHERMAN AVENUE",
            "address_2": "BUILDING 2 UNIT C",
            "city": "VINELAND",
            "state": "NJ",
            "postal_code": "08360",
            "telephone_number": "856-362-5259",
            "fax_number": "856-405-6978"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "STEPHENSON",
        "first_name": "DEREK",
        "middle_name": "ALLEN",
        "name_prefix": "Dr.",
        "credential": "M.D.",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2008-06-24",
        "last_updated": "2019-12-31",
        "certification_date": "2019-12-31",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "390200000X",
            "taxonomy_group": "",
            "desc": "Student in an Organized Health Care Education/Training Program",
            "state": "FL",
            "license": "ME116873",
            "primary": false
        },
        {
            "code": "208600000X",
            "taxonomy_group": "",
            "desc": "Surgery",
            "state": "AZ",
            "license": "R70529",
            "primary": false
        },
        {
            "code": "208600000X",
            "taxonomy_group": "",
            "desc": "Surgery",
            "state": "NJ",
            "license": "25MA09618900",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "0475025",
            "state": "NJ"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Vineland, NJ

Sources for this page

Verify at the official NPI Registry.