Derrick Wayne Raburn, PT

Primary specialty

Physical TherapistTaxonomy code 225100000X

License

PT20241 Issued in CA

Practice address

78078 Country Club Dr
Suite 205
Bermuda Dunes, CA 92203-8173

Phone

(760) 345-9934

Fax

(760) 345-3086

NPI assigned

Jun 1, 2006

Last updated

Jul 8, 2007By the provider in NPPES

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

Other identifiers 1

Other names 1

• Rick Raburn Other name

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

HHS exclusion list flag

CMS’s directory marks this NPI as on an HHS exclusion list; no matching OIG record was found. The OIG exclusions file (LEIE) holds no record for this NPI, and the directory does not say which list the flag comes from. How exclusions are shown Confirm with the OIG exclusions search.

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.

• Macdremma, Inc

  dba anytime fitness

  • Physical Medicine & Rehabilitation Physician
  • Cathedral City, CA
  • NPI 1306424148
  NPD (past)

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

{
    "created_epoch": "1149120000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1183852800000",
    "number": "1831136308",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "78078 COUNTRY CLUB DR",
            "address_2": "SUITE 205",
            "city": "BERMUDA DUNES",
            "state": "CA",
            "postal_code": "922038173",
            "telephone_number": "760-345-9934",
            "fax_number": "760-345-3086"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "78078 COUNTRY CLUB DR",
            "address_2": "SUITE 205",
            "city": "BERMUDA DUNES",
            "state": "CA",
            "postal_code": "922038173",
            "telephone_number": "760-345-9934",
            "fax_number": "760-345-3086"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "RABURN",
        "first_name": "DERRICK",
        "middle_name": "WAYNE",
        "credential": "PT",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-06-01",
        "last_updated": "2007-07-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "225100000X",
            "taxonomy_group": "",
            "desc": "Physical Therapist",
            "state": "CA",
            "license": "PT20241",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "PPIN - MEDICARE #",
            "identifier": "0PT202413",
            "state": "CA"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "RICK",
            "last_name": "RABURN",
            "credential": "PT",
            "code": "5",
            "type": "Other Name"
        }
    ]
}

• Michelle Parker, RN
• Dhruv Rohitkumar Patel, PHARM.D
• Samantha Renee Peters, PT, DPT, ATC
• Craig Daniel Pillow, DPT
• Meko Yvette Porter, DO
• Ralphs Grocery Company (Ralphs Pharmacy)
• Edward Anthony Ramirez
• Janet Lee Roberts, M.D.
• Brandon Rosi, PT, DPT, CSCS
• Scott Russell, DO

• Physical Therapist in Bermuda Dunes, CA
• Providers in Bermuda Dunes, CA by specialty
• Physical Therapist in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 8, 2007; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.