Active NPI
Killian James Derusha, LMSW
- Social Worker
- Lawrence, KS
National Provider Identifier
1851811756
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Social Worker
- License
- 10470
- Practice address
- 1311 Wakarusa Dr Ste 2100
Lawrence, KS 66049-4775 - Phone
- (785) 424-7770
- Fax
- (785) 843-2219
- NPI assigned
- Jun 21, 2017
- Last updated
- Oct 27, 2022
- 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 |
|---|---|---|---|---|
| Social Worker | 104100000X | 10470 | KS | Primary |
Addresses
Primary practice location
1311 Wakarusa Dr Ste 2100
Lawrence, KS 66049-4775
Mailing address
1311 Wakarusa Dr Ste 2100
Lawrence, KS 66049-4775
Other practice location 1
1307 Massachusetts St
Lawrence, KS 66044-3431
Phone (785) 424-7770
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 3004349890002 | Medicaid | KS |
Other names 1
- Sierra Destiny Derusha
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
- Eligible to order & refer
- Part B services: No
- Medical equipment: Yes
- Home health: No
- Power mobility devices: No
- Hospice: No
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 10470 | KS | MD | Pharmacist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1498003200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1666828800000",
"number": "1851811756",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "1311 WAKARUSA DR STE 2100",
"city": "LAWRENCE",
"state": "KS",
"postal_code": "660494775",
"fax_number": "785-843-2219"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1311 WAKARUSA DR STE 2100",
"city": "LAWRENCE",
"state": "KS",
"postal_code": "660494775",
"telephone_number": "785-424-7770",
"fax_number": "785-843-2219"
}
],
"practiceLocations": [
{
"address_1": "1307 Massachusetts St",
"address_purpose": "LOCATION",
"city": "Lawrence",
"state": "KS",
"postal_code": "660443431",
"country_code": "US",
"telephone_number": "785-424-7770",
"country_name": "United States",
"address_type": "DOM"
}
],
"basic": {
"last_name": "DERUSHA",
"first_name": "KILLIAN",
"middle_name": "JAMES",
"credential": "LMSW",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2017-06-21",
"last_updated": "2022-10-27",
"certification_date": "2022-10-27",
"status": "A"
},
"taxonomies": [
{
"code": "104100000X",
"taxonomy_group": "",
"desc": "Social Worker",
"state": "KS",
"license": "10470",
"primary": true
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "3004349890002",
"state": "KS"
}
],
"endpoints": [],
"other_names": [
{
"first_name": "SIERRA",
"last_name": "DERUSHA",
"middle_name": "DESTINY",
"code": "1",
"type": "Former Name"
}
]
}Other providers in Lawrence, KS
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 27, 2022; 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.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.