Individual provider Active NPI

Derek H Hancock, APN

  • Family Nurse Practitioner
  • Jonesboro, AR
National Provider Identifier
1801228663
Registry record updated Sep 30, 2013
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Nurse PractitionerTaxonomy code 363LF0000X
License
A003900 Issued in AR
Practice address
225 E Jackson Ave
Jonesboro, AR 72401-3119
Phone
(870) 207-1630
Fax
(870) 207-6581
NPI assigned
Aug 4, 2013
Sex
Male
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Sep 30, 2013

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Family Nurse Practitioner 363LF0000X A003900 AR Primary

Addresses

Primary practice location

225 E Jackson Ave
Jonesboro, AR 72401-3119

Mailing address

6032 Beaver Creek LN
Jonesboro, AR 72404-9558
Phone (501) 412-4777

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in AR
Eligible to order & refer
  • Part B services: Yes
  • Medical equipment: Yes
  • Home health: Yes
  • Power mobility devices: Yes
  • Hospice: No
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20160427000649 AR Practitioner - Nurse Practitioner 4082913959 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Nurse Practitioner
Education
Other, 2013
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
St Bernards Hospital Inc.Group PAC ID 0941105480, 187 clinicians

Practice addresses (Care Compare)

1201 Fleming Ave
Jonesboro, AR 72401-4311
Phone (870) 932-0440

225 E Washington Ave
Jonesboro, AR 72401-3111

Hospital & facility affiliations

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Nurse Practitioner

Practice roles

OrganizationSpecialtyStatusNew patients
St Bernards Hospital Inc. CurrentSince Jan 27, 2016 Accepting new patients

Locations

1201 Fleming Ave
Jonesboro, AR 72401
Phone (870) 932-0440

225 E Jackson Ave
Jonesboro, AR 72401
Phone (870) 207-1630

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.

Hospital & facility affiliations 1

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

NPI Registry JSON

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

{
    "created_epoch": "1375574400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1380499200000",
    "number": "1801228663",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "6032 BEAVER CREEK LN",
            "city": "JONESBORO",
            "state": "AR",
            "postal_code": "724049558",
            "telephone_number": "501-412-4777"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "225 E JACKSON AVE",
            "city": "JONESBORO",
            "state": "AR",
            "postal_code": "724013119",
            "telephone_number": "870-207-1630",
            "fax_number": "870-207-6581"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "HANCOCK",
        "first_name": "DEREK",
        "middle_name": "H",
        "credential": "APN",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2013-08-04",
        "last_updated": "2013-09-30",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LF0000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Family",
            "state": "AR",
            "license": "A003900",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Jonesboro, AR

Sources for this page

Verify at the official NPI Registry.