Individual provider Active NPI

Sarkis Christopher Derderian, M.D.

  • Pediatric Surgery Physician
  • Aurora, CO
National Provider Identifier
1831416387
Registry record updated Oct 3, 2023
On this page

Key facts

NPPES NPI Registry
Primary specialty
Pediatric Surgery PhysicianTaxonomy code 2086S0120X
License
DR.0059356 Issued in CO
Practice address
13123 E 16TH Ave
Aurora, CO 80045-7106
Phone
(720) 777-1234
NPI assigned
Apr 23, 2010
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Oct 3, 2023

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Surgery Physician 208600000X A123860 CA
Pediatric Surgery Physician 2086S0120X DR.0059356 CO Primary

Addresses

Primary practice location

13123 E 16TH Ave
Aurora, CO 80045-7106

Mailing address

PO Box 110429
Aurora, CO 80042-0429

Other practice location 1

12605 E 16th Ave
Aurora, CO 80045-2545
Phone (720) 777-1234

Other names 1

  • Chris Derderian III Other name

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in CO
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.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20210819000720 CO Practitioner - General SurgeryPractitioner - Pediatric Medicine 4284990938 Reassigns benefits to 2 organizations

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Doctor of Medicine

State licenses

LicenseStateTypeSpecialty
A123860CAMDSurgery Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Denver Health and Hospital Authority CurrentSince Aug 1, 2021 Accepting new patients
University Physicians Incorporated CurrentSince Sep 1, 2021 Accepting new patients
University Physicians Incorporated Surgery Current Accepting new patients
University Physicians, Incorporated CurrentSince Sep 1, 2021 Accepting new patients
Denver Health and Hospital Authority CurrentSince Aug 1, 2021 Accepting new patients
Children'S Hospital Colorado Current Accepting new patients
Denver Health and Hospital Authority Past Accepting new patients
Children'S Hospital Colorado Past Accepting new patients

Locations

13123 E 16th Ave
Fl 4
Aurora, CO 80045
Phone (303) 724-6277

13123 E 16th Ave
Aurora, CO 80045
Phone (720) 777-3846

12605 E 16th Ave
Aurora, CO 80045
Phone (720) 848-0006

13123 E 16th Ave
Ste B130
Aurora, CO 80045

777 Bannock St
Ste MC3450
Denver, CO 80204

777 Bannock St
Denver, CO 80204

Dept 1061
Denver, CO 80256

Interoperability endpoints

  • Direct secure messaging: sderderian97465@direct.childrenscolorado.org
  • Direct secure messaging: sderderian111092@direct.dhha.org

Organizations & group practices 8

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": "1271980800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1696291200000",
    "number": "1831416387",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 110429",
            "city": "AURORA",
            "state": "CO",
            "postal_code": "800420429"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "13123 E 16TH AVE",
            "city": "AURORA",
            "state": "CO",
            "postal_code": "800457106",
            "telephone_number": "720-777-1234"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "12605 E 16th Ave",
            "address_purpose": "LOCATION",
            "city": "Aurora",
            "state": "CO",
            "postal_code": "800452545",
            "country_code": "US",
            "telephone_number": "720-777-1234",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "DERDERIAN",
        "first_name": "SARKIS",
        "middle_name": "CHRISTOPHER",
        "name_prefix": "Dr.",
        "credential": "M.D.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2010-04-23",
        "last_updated": "2023-10-03",
        "certification_date": "2023-10-03",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "208600000X",
            "taxonomy_group": "",
            "desc": "Surgery",
            "state": "CA",
            "license": "A123860",
            "primary": false
        },
        {
            "code": "2086S0120X",
            "taxonomy_group": "",
            "desc": "Surgery, Pediatric Surgery",
            "state": "CO",
            "license": "DR.0059356",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "CHRIS",
            "last_name": "DERDERIAN",
            "suffix": "III",
            "credential": "M.D.",
            "code": "5",
            "type": "Other Name"
        }
    ]
}

Other providers in Aurora, CO

Sources for this page

Verify at the official NPI Registry.