Active NPI
Derrick Jerome Showalter
- Driver
- Princeton, WV
National Provider Identifier
1740856848
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Driver
- License
- F341538
- Practice address
- 1122 Mercer St
Princeton, WV 24740-3030 - Phone
- (304) 800-0544
- NPI assigned
- May 28, 2021
- Last updated
- May 28, 2021
- 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 |
|---|---|---|---|---|
| Driver | 172A00000X | F341538 | WV | Primary |
Addresses
Primary practice location
1122 Mercer St
Princeton, WV 24740-3030
Mailing address
1122 Mercer St
Princeton, WV 24740-3030
Phone (304) 800-0544
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
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| F341538 | WV | MD | Driver |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| S/B Transportation, LLC | Driver | Current | Accepting new patients |
Locations
1122 Mercer St
Princeton, WV 24740
Phone (304) 800-0544
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.
-
- Driver
- Princeton, WV
- NPI 1598522450
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1622160000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1622160000000",
"number": "1740856848",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "1122 MERCER ST",
"city": "PRINCETON",
"state": "WV",
"postal_code": "247403030",
"telephone_number": "304-800-0544"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1122 MERCER ST",
"city": "PRINCETON",
"state": "WV",
"postal_code": "247403030",
"telephone_number": "304-800-0544"
}
],
"practiceLocations": [],
"basic": {
"last_name": "SHOWALTER",
"first_name": "DERRICK",
"middle_name": "JEROME",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2021-05-28",
"last_updated": "2021-05-28",
"certification_date": "2021-05-28",
"status": "A"
},
"taxonomies": [
{
"code": "172A00000X",
"taxonomy_group": "",
"desc": "Driver",
"state": "WV",
"license": "F341538",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Princeton, WV
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 28, 2021; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.