Paul J Derden, MD

Primary specialty

Family Medicine PhysicianTaxonomy code 207Q00000X

License

0101036190 Issued in VA

Practice address

403 Princeton Rd Ste 10
Johnson City, TN 37601-2062

Phone

(423) 431-7340

NPI assigned

Jan 30, 2006

Sex

Male

Sole proprietor

No

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

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Eligible to order & refer

• Part B services: No
• Medical equipment: Yes
• Home health: No
• Power mobility devices: Yes
• Hospice: No

Green means eligible to order or refer.

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Medicine

State licenses

Practice roles

Locations

Interoperability endpoints

• Direct secure messaging: paul.derden.1@17155.direct.athenahealth.com

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.

• Blue Ridge Medical Management C Orporation

  • Internal Medicine Physician
  • Johnson City, TN
  • NPI 1861013864
  NPD
• Blue Ridge Medical Management Corporation

  • Cardiovascular Disease Physician
  • Marion, VA
  • NPI 1326159567
  NPD

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

{
    "created_epoch": "1138579200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1724112000000",
    "number": "1780655613",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1021 W OAKLAND AVE STE 310",
            "city": "JOHNSON CITY",
            "state": "TN",
            "postal_code": "376042192",
            "telephone_number": "423-302-6565"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "403 PRINCETON RD STE 10",
            "city": "JOHNSON CITY",
            "state": "TN",
            "postal_code": "376012062",
            "telephone_number": "423-431-7340"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "602 W Morgan Ave",
            "address_2": "Suite 3",
            "address_purpose": "LOCATION",
            "city": "Pennington Gap",
            "state": "VA",
            "postal_code": "242772036",
            "country_code": "US",
            "telephone_number": "276-546-5310",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "24530 Falcon Place Blvd Ste 200",
            "address_purpose": "LOCATION",
            "city": "Abingdon",
            "state": "VA",
            "postal_code": "242117665",
            "country_code": "US",
            "telephone_number": "276-628-1654",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "DERDEN",
        "first_name": "PAUL",
        "middle_name": "J",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-01-30",
        "last_updated": "2024-08-20",
        "certification_date": "2024-08-20",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "VA",
            "license": "0101036190",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Larry Edward Denny, DMD
• Ariel Denton, APN
• Chloe Denton, RBT
• Elizabeth Depasquale, DO
• Ashlie Katelyn Depew, LCSW
• Dermatolgy & Dermatologic Surgery PC
• David T Deroos, DO
• Margaret Claire Deroos, DO
• Angela D Deschner, FNP-BC
• Mitchell Deshazer

• Family Medicine Physician in Johnson City, TN
• Providers in Johnson City, TN by specialty
• Family Medicine Physician in Tennessee

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 20, 2024; 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.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.