Active NPI
Dale E Derick, M.D.
- Obstetrics & Gynecology Physician
- Sylvania, OH
National Provider Identifier
1750387643
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Obstetrics & Gynecology Physician
- License
- 35044704
- Practice address
- 5300 Harroun Rd
Suite 304
Sylvania, OH 43560-2182 - Phone
- (419) 824-1100
- Fax
- (419) 824-1771
- NPI assigned
- Jun 24, 2005
- 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 |
|---|---|---|---|---|
| Obstetrics & Gynecology Physician | 207V00000X | 35044704 | OH | Primary |
Addresses
Primary practice location
5300 Harroun Rd
Suite 304
Sylvania, OH 43560-2182
Mailing address
5300 Harroun Rd
Suite 304
Sylvania, OH 43560-2182
Phone (419) 824-1100
Other identifiers 13
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 000000142525 | Other | OH | ANTHEM |
| 344428256 | Other | CA | BEECH STREET |
| 000000385212 | Other | OH | ANTHEM COMMERICAL |
| 0458802 | Medicaid | OH | |
| 344428256 | Other | OH | EMERALD |
| 4002382 | Other | OH | AETNA |
| 142491 | Other | MI | PRIORITY HEALTH |
| PH00240649 | Other | OH | NATIONWIDE |
| 4826635 | Medicaid | MI | |
| 2974411950-006 | Other | OH | MEDICAL MUTUAL |
| 0000004002383 | Other | OH | ANTHEM MEDICAID |
| 142491 | Other | OH | CARE CHOICES |
| 8081472 | Other | OH | CIGNA |
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)
- Enrolled
- Credentials
- Doctor of Medicine
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 35044704 | OH | MD | Obstetrics & Gynecology Physician |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1119571200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1395100800000",
"number": "1750387643",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "5300 HARROUN RD",
"address_2": "SUITE 304",
"city": "SYLVANIA",
"state": "OH",
"postal_code": "435602182",
"telephone_number": "419-824-1100",
"fax_number": "419-824-1771"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "5300 HARROUN RD",
"address_2": "SUITE 304",
"city": "SYLVANIA",
"state": "OH",
"postal_code": "435602182",
"telephone_number": "419-824-1100",
"fax_number": "419-824-1771"
}
],
"practiceLocations": [],
"basic": {
"last_name": "DERICK",
"first_name": "DALE",
"middle_name": "E",
"credential": "M.D.",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2005-06-24",
"last_updated": "2014-03-18",
"status": "A"
},
"taxonomies": [
{
"code": "207V00000X",
"taxonomy_group": "",
"desc": "Obstetrics & Gynecology",
"state": "OH",
"license": "35044704",
"primary": true
}
],
"identifiers": [
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "ANTHEM",
"identifier": "000000142525",
"state": "OH"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "BEECH STREET",
"identifier": "344428256",
"state": "CA"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "ANTHEM COMMERICAL",
"identifier": "000000385212",
"state": "OH"
},
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "0458802",
"state": "OH"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "EMERALD",
"identifier": "344428256",
"state": "OH"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "AETNA",
"identifier": "4002382",
"state": "OH"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "PRIORITY HEALTH",
"identifier": "142491",
"state": "MI"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "NATIONWIDE",
"identifier": "PH00240649",
"state": "OH"
},
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "4826635",
"state": "MI"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "MEDICAL MUTUAL",
"identifier": "2974411950-006",
"state": "OH"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "ANTHEM MEDICAID",
"identifier": "0000004002383",
"state": "OH"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "CARE CHOICES",
"identifier": "142491",
"state": "OH"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "CIGNA",
"identifier": "8081472",
"state": "OH"
}
],
"endpoints": [],
"other_names": []
}Other providers in Sylvania, OH
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 18, 2014; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.