Derek Wade Puckett, RPT

Primary specialty

Physical TherapistTaxonomy code 225100000X

License

PT1702 Issued in MS

Practice address

3000 Hwy 49 South
Florence, MS 39073

Phone

(601) 845-8282

Fax

(601) 845-8290

NPI assigned

Oct 2, 2006

Sex

Male

Sole proprietor

Yes

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

Enrolled in MS

Enrollment records 1

Specialty

Physical Therapist in Private Practice

Education

Other, 1995

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Practice addresses (Care Compare)

Medicare enrollment (NPD)

Enrolled

Practice roles

Locations

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.

• Florence Rehabilitation Center,Inc.

  • Physical Therapist
  • Florence, MS
  • NPI 1649560046

  MS, Physical Therapist

  Medicare reassignment NPD

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

{
    "created_epoch": "1159747200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1300838400000",
    "number": "1851484422",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3000 HWY 49 SOUTH",
            "city": "FLORENCE",
            "state": "MS",
            "postal_code": "39073",
            "telephone_number": "601-845-8282",
            "fax_number": "601-845-8290"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3000 HWY 49 SOUTH",
            "city": "FLORENCE",
            "state": "MS",
            "postal_code": "39073",
            "telephone_number": "601-845-8282",
            "fax_number": "601-845-8290"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "PUCKETT",
        "first_name": "DEREK",
        "middle_name": "WADE",
        "name_prefix": "Mr.",
        "credential": "RPT",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2006-10-02",
        "last_updated": "2011-03-23",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "225100000X",
            "taxonomy_group": "",
            "desc": "Physical Therapist",
            "state": "MS",
            "license": "PT1702",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "00116390",
            "state": "MS"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Peace of Mind Counseling and Consultation, PLLC
• Emily Holder Peacock, OTD, OTR/L
• Amanda Perkins
• Physiotherapy Associates Inc
• Polks Discount Drugs #2
• Norma M Raymond, RPH
• Laurie Robinson, NP
• Abbey Ross, NP
• Julian Sandifer Jr., FNP-C
• Regina Ann Scott, OTRL

• All providers in Florence, MS
• Physical Therapist in Mississippi

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 23, 2011; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
• 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.