Active NPI
Gael Derouin, DO
- Otolaryngology Physician
- Phoenix, AZ
National Provider Identifier
1821042078
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Otolaryngology Physician
- License
- 3052
- Practice address
- 2525 E Roosevelt St
Phoenix, AZ 85008-4948 - Phone
- (602) 344-1015
- NPI assigned
- May 20, 2006
- Sex
- Male
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Otolaryngology Physician | 207Y00000X | 3052 | AZ | Primary |
Addresses
Primary practice location
2525 E Roosevelt St
Phoenix, AZ 85008-4948
Mailing address
2929 E Thomas Rd
Phoenix, AZ 85016-8034
Phone (602) 470-5000
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 581927 | Medicaid | AZ |
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 Osteopathy, Doctor of Medicine
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| District Medical Group, Inc | Family Medicine | Past | Accepting new patients |
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.
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1148083200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1221782400000",
"number": "1821042078",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "2929 E THOMAS RD",
"city": "PHOENIX",
"state": "AZ",
"postal_code": "850168034",
"telephone_number": "602-470-5000"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "2525 E ROOSEVELT ST",
"city": "PHOENIX",
"state": "AZ",
"postal_code": "850084948",
"telephone_number": "602-344-1015"
}
],
"practiceLocations": [],
"basic": {
"last_name": "DEROUIN",
"first_name": "GAEL",
"credential": "DO",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2006-05-20",
"last_updated": "2008-09-19",
"status": "A"
},
"taxonomies": [
{
"code": "207Y00000X",
"taxonomy_group": "",
"desc": "Otolaryngology",
"state": "AZ",
"license": "3052",
"primary": true
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "581927",
"state": "AZ"
}
],
"endpoints": [],
"other_names": []
}Other providers in Phoenix, AZ
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 19, 2008; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.