NPIMap

Individual provider Active NPI

David L Deregis, MD

  • Occupational Medicine Physician
  • Sayre, PA
National Provider Identifier
1770689895
Registry record updated Dec 13, 2011
On this page

Key facts

NPPES NPI Registry
Primary specialty
Occupational Medicine PhysicianTaxonomy code 2083X0100X
License
35991 Issued in KY
Practice address
1 Guthrie SQ
Attention: Provider Services Vicky Detrick
Sayre, PA 18840-1625
Phone
(570) 887-6323
Fax
(570) 887-6324
NPI assigned
Sep 16, 2006
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Dec 13, 2011

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Internal Medicine Physician 207R00000X 35991 KY
Occupational Medicine Physician 2083X0100X 35991 KY Primary

Addresses

Primary practice location

1 Guthrie SQ
Attention: Provider Services Vicky Detrick
Sayre, PA 18840-1625

Mailing address

1 Guthrie SQ
Attention: Provider Services Vicky Detrick
Sayre, PA 18840-1625
Phone (570) 887-6323

Other identifiers 3

IdentifierTypeStateIssuer
000000236623OtherBCBS PROVIDER NUMBER
35991OtherKYLICENSE
64018898MedicaidKY

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

Practice roles

OrganizationSpecialtyStatusNew patients
Lexington County Health Services District Inc Current Accepting new patients
Figtree DME Past Accepting new patients
Tennessee Heart and Lung Institute PLC Past Accepting new patients
Owensboro Health Medical Group, Inc Internal Medicine Past Accepting new patients

Interoperability endpoints

  • Direct secure messaging: dderegis173545@direct.lexmed.com

Organizations & group practices 4

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.

NPI Registry JSON

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

{
    "created_epoch": "1158364800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1323734400000",
    "number": "1770689895",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1 GUTHRIE SQ",
            "address_2": "ATTENTION: PROVIDER SERVICES VICKY DETRICK",
            "city": "SAYRE",
            "state": "PA",
            "postal_code": "188401625",
            "telephone_number": "570-887-6323",
            "fax_number": "570-887-6324"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1 GUTHRIE SQ",
            "address_2": "ATTENTION: PROVIDER SERVICES VICKY DETRICK",
            "city": "SAYRE",
            "state": "PA",
            "postal_code": "188401625",
            "telephone_number": "570-887-6323",
            "fax_number": "570-887-6324"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "DEREGIS",
        "first_name": "DAVID",
        "middle_name": "L",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-09-16",
        "last_updated": "2011-12-13",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207R00000X",
            "taxonomy_group": "",
            "desc": "Internal Medicine",
            "state": "KY",
            "license": "35991",
            "primary": false
        },
        {
            "code": "2083X0100X",
            "taxonomy_group": "",
            "desc": "Preventive Medicine, Occupational Medicine",
            "state": "KY",
            "license": "35991",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BCBS PROVIDER NUMBER",
            "identifier": "000000236623",
            "state": null
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "LICENSE",
            "identifier": "35991",
            "state": "KY"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "64018898",
            "state": "KY"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Sayre, PA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 13, 2011; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.