Jeremy Derickson, PA-C

Primary specialty

Physician AssistantTaxonomy code 363A00000X

Practice address

3720 E Pueblo Ave
Mesa, AZ 85206-1821

Phone

(928) 200-3526

NPI assigned

Aug 31, 2016

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

Enrolled in AZ

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

Specialty

Physician Assistant

Education

At Still University, Arizona School of Dentistry & Oral HLTH, 2016

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

Brown Road Family Medicine, PLLCGroup PAC ID 5395781769, 6 clinicians

Practice addresses (Care Compare)

Medicare enrollment (NPD)

Enrolled

Credentials

Physician Assistant

State licenses

Interoperability endpoints

• Direct secure messaging: jeremy.derickson.p1@direct.brfmvmed.nextgenshare.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.

• Brown Road Family Medicine, PLLC

  • Preferred Provider Organization
  • Mesa, AZ
  • NPI 1518081066
  Medicare reassignment Care Compare group

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

{
    "created_epoch": "1472601600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1477008000000",
    "number": "1821544503",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2310 E BROWN RD",
            "city": "MESA",
            "state": "AZ",
            "postal_code": "852135226",
            "telephone_number": "480-649-9000",
            "fax_number": "480-248-9206"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3720 E PUEBLO AVE",
            "city": "MESA",
            "state": "AZ",
            "postal_code": "852061821",
            "telephone_number": "928-200-3526"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "DERICKSON",
        "first_name": "JEREMY",
        "credential": "PA-C",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2016-08-31",
        "last_updated": "2016-10-21",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "AZ",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Juancho C. Depaolo, CRNA
• Dependable Mental Health Care
• Melissa Deppe
• Jennica Deren
• Armen Derian, M.D.
• Laurie A Derose, RN
• Danielle Paige Derrick, LPC
• Santosh Desai, DO
• Sonal Desai, O.D.
• Spencer Desanti, DMD

• Physician Assistant in Mesa, AZ
• Providers in Mesa, AZ by specialty
• Physician Assistant in Arizona

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 21, 2016; 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.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.