Wondwossen Yilma Dererie, M.D.

Primary specialty

Internal Medicine PhysicianTaxonomy code 207R00000X

License

0101254930 Issued in VA

Practice address

2800 Godwin Blvd
Suffolk, VA 23434-8038

Phone

(757) 934-4000

NPI assigned

Jun 23, 2010

Last updated

Oct 4, 2021By the provider in NPPES

Sex

Male

Sole proprietor

Yes

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

Specialties & licenses 2

Addresses

Medicare fee-for-service enrollment

Enrolled in VA, OH2 enrollments

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: Yes
• Power mobility devices: Yes
• Hospice: Yes

Green means eligible to order or refer.

Enrollment records 2

Specialty

HospitalistAlso: Internal Medicine

Education

Other, 2003

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

Licking Memorial Health ProfessionalsGroup PAC ID 6204740731, 235 clinicians

Practice addresses (Care Compare)

Hospital & facility affiliations

• Licking Memorial Hospital Hospital, Newark, OH, CCN 360218

Merit-based Incentive Payment System (MIPS)

Final score

85.98 of 100Reported as group

Quality

75.66

Promoting interoperability

100

Improvement activities

40

Cost

75.38

Merit-based Incentive Payment System (MIPS)

Final score

89.83 of 100Reported as group

Quality

78.11

Improvement activities

40

Cost

74.76

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Medicine

State licenses

Practice roles

Locations

Interoperability endpoints

• Direct secure messaging: wdererie853806@direct.osumc.edu

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.

• Licking Memorial Health Professionals

  • Family Medicine Physician
  • Newark, OH
  • NPI 1326072265
  Medicare reassignment Care Compare group NPD
• Apogee Medical Group Ohio Inc

  • Internal Medicine Physician
  • Ashtabula, OH
  • NPI 1477500999
  Medicare reassignment NPD
• Ohio Valley Physicians Inc

  dba Access Care

  • Family Medicine Physician
  • Huntington, WV
  • NPI 1962433177

  OH

  Medicare reassignment NPD
• Licking Memorial Professional Corporation

  dba Licking Memorial Orthopedic DME

  • Durable Medical Equipment & Medical Supplies
  • Newark, OH
  • NPI 1326436510
  NPD
• Ohio Valley Physicians Inc

  dba OVP Health

  • Rural Health Clinic/Center
  • Eastern, KY
  • NPI 1164129599
  NPD
• Licking Memorial Hospital

  • General Acute Care Hospital
  • Newark, OH
  • NPI 1568446755
  NPD (past)

Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.

• Licking Memorial Hospital

  • General Acute Care Hospital
  • Newark, OH
  • NPI 1568446755
  Care Compare affiliation

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1277251200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1633305600000",
    "number": "1760793897",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "5102 WINDBREAK DR",
            "city": "FREDERICKSBURG",
            "state": "VA",
            "postal_code": "224079323",
            "telephone_number": "857-998-8902"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2800 GODWIN BLVD",
            "city": "SUFFOLK",
            "state": "VA",
            "postal_code": "234348038",
            "telephone_number": "757-934-4000"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "DERERIE",
        "first_name": "WONDWOSSEN",
        "middle_name": "YILMA",
        "name_prefix": "Dr.",
        "credential": "M.D.",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2010-06-23",
        "last_updated": "2021-10-04",
        "certification_date": "2021-10-04",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207R00000X",
            "taxonomy_group": "",
            "desc": "Internal Medicine",
            "state": "OH",
            "license": "35.130138",
            "primary": false
        },
        {
            "code": "207R00000X",
            "taxonomy_group": "",
            "desc": "Internal Medicine",
            "state": "VA",
            "license": "0101254930",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Rachel Denison, MSN, APRN, PMHNP-BC
• Dental Professionals of Virginia, P.C. (LWSS Family Dentistry - Suffolk)
• Dental Professionals of Virginia, P.C. (Suffolk Complete Dental Care)
• Elizabeth Mary Denzer, M.S
• Deowee Dialysis LLC (Nansemond Dialysis)
• Jane Marie Derrig, DO
• Dirghayu Desai, MD
• Destined Day Services, LLC
• Jared Detrick, RBT
• Jenelle Detten

• Internal Medicine Physician in Suffolk, VA
• Providers in Suffolk, VA by specialty
• Internal Medicine Physician in Virginia

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 4, 2021; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.