Cheri Diane Dersam, M.D.

Primary specialty

Emergency Medicine PhysicianTaxonomy code 207P00000X

License

31114 Issued in AZ

Practice address

4730 E Indian School Rd
Suite 211
Phoenix, AZ 85018-5441

Phone

(602) 354-3491

NPI assigned

Aug 3, 2006

Last updated

Oct 20, 2007By the provider in NPPES

Sex

Female

Sole proprietor

No

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

Specialties & licenses 1

Addresses

Other identifiers 1

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

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.

Opted out of Medicare

Yes, effective Oct 26, 2016 through Oct 26, 2026

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Medicine

State licenses

Practice roles

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.

• District Medical Group, Inc

  • Internal Medicine Physician
  • Phoenix, AZ
  • NPI 1295968162
  NPD (past)
• Emurgent Care PLLC

  dba Arcadia Urgent Care

  • Urgent Care Clinic/Center
  • Phoenix, AZ
  • NPI 1801997077
  NPD (past)
• Nextcare Arizona I JV LLC

  • Urgent Care Clinic/Center
  • Tempe, AZ
  • NPI 1114798071
  NPD (past)
• North Valley Emergency Specialists

  • Emergency Medicine Physician
  • Glendale, AZ
  • NPI 1285655209
  NPD (past)

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

{
    "created_epoch": "1154563200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1192838400000",
    "number": "1811905177",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "6131 E CALLE ROSA",
            "city": "SCOTTSDALE",
            "state": "AZ",
            "postal_code": "852514222",
            "telephone_number": "480-874-5835"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4730 E INDIAN SCHOOL RD",
            "address_2": "SUITE 211",
            "city": "PHOENIX",
            "state": "AZ",
            "postal_code": "850185441",
            "telephone_number": "602-354-3491"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "DERSAM",
        "first_name": "CHERI",
        "middle_name": "DIANE",
        "name_prefix": "Dr.",
        "credential": "M.D.",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2006-08-03",
        "last_updated": "2007-10-20",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207P00000X",
            "taxonomy_group": "",
            "desc": "Emergency Medicine",
            "state": "AZ",
            "license": "31114",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "77634604",
            "state": "AZ"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Gael Derouin, DO
• Pamela Louise Derouin, MD
• Derrick S. Hines M.D. P.C.
• Derrick Umphlett MD PC
• Brenda Joyce Derrick, LPN
• Michael D Dersam, MD
• Anne Merrylees Dersch, MD
• Michael H Dershowitz, DPM
• Shockie M Dersno, LPC
• Jenna Derubeis, OD

• Emergency Medicine Physician in Phoenix, AZ
• Providers in Phoenix, AZ by specialty
• Emergency Medicine Physician in Arizona

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 20, 2007; 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; Opt Out Affidavits.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.