Active NPI
Kerri D Derrevere, MD
- Pediatrics Physician
- Portland, OR
National Provider Identifier
1760611164
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Pediatrics Physician
- License
- MD158142
- Practice address
- 707 SW Gaines St
Portland, OR 97239-2901 - Phone
- (405) 990-8777
- NPI assigned
- Jul 7, 2009
- Sex
- Female
- 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 |
|---|---|---|---|---|
| Pediatrics Physician | 208000000X | MD158142 | OR | Primary |
Addresses
Primary practice location
707 SW Gaines St
Portland, OR 97239-2901
Mailing address
707 SW Gaines St
Portland, OR 97239-2901
Phone (405) 990-8777
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 |
|---|---|---|---|
| MD158142 | OR | MD | Pediatrics Physician |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| The Children'S Center, Inc. | 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.
-
- Children's Hospital
- Bethany, OK
- NPI 1740395409
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1246924800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1424822400000",
"number": "1760611164",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "707 SW GAINES ST",
"city": "PORTLAND",
"state": "OR",
"postal_code": "972392901",
"telephone_number": "405-990-8777"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "707 SW GAINES ST",
"city": "PORTLAND",
"state": "OR",
"postal_code": "972392901",
"telephone_number": "405-990-8777"
}
],
"practiceLocations": [],
"basic": {
"last_name": "DERREVERE",
"first_name": "KERRI",
"middle_name": "D",
"credential": "MD",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2009-07-07",
"last_updated": "2015-02-25",
"status": "A"
},
"taxonomies": [
{
"code": "208000000X",
"taxonomy_group": "",
"desc": "Pediatrics",
"state": "OR",
"license": "MD158142",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Portland, OR
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 25, 2015; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.