Derek Sean Bumgarner, M.D.

Primary specialty

Anatomic Pathology & Clinical Pathology PhysicianTaxonomy code 207ZP0102X

License

036.138853 Issued in IL

Practice address

2160 S 1St Ave
Department of Pathology Building 110 Room 2209
Maywood, IL 60153-3328

Phone

(708) 216-3250

Fax

(708) 327-2620

NPI assigned

Mar 19, 2013

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

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: Yes
• Hospice: No

Green means eligible to order or refer.

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Medicine

State licenses

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

{
    "created_epoch": "1363651200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1438905600000",
    "number": "1861734683",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2160 S 1ST AVE",
            "address_2": "DEPARTMENT OF PATHOLOGY BUILDING 110 ROOM 2209",
            "city": "MAYWOOD",
            "state": "IL",
            "postal_code": "601533328",
            "telephone_number": "708-216-3250",
            "fax_number": "708-327-2620"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2160 S 1ST AVE",
            "address_2": "DEPARTMENT OF PATHOLOGY BUILDING 110 ROOM 2209",
            "city": "MAYWOOD",
            "state": "IL",
            "postal_code": "601533328",
            "telephone_number": "708-216-3250",
            "fax_number": "708-327-2620"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "BUMGARNER",
        "first_name": "DEREK",
        "middle_name": "SEAN",
        "name_prefix": "Dr.",
        "credential": "M.D.",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2013-03-19",
        "last_updated": "2015-08-07",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207ZP0102X",
            "taxonomy_group": "",
            "desc": "Pathology, Anatomic Pathology & Clinical Pathology",
            "state": "IL",
            "license": "036.138853",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Kelly Victoria Buh
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• Jonathan Aurel Builta, DO
• Katie Margaret Bukiri, MD
• Alexandra Bullough, MD
• Corinne Bunn
• Patrick Buoniconti, MD
• John William Burger, M.D.
• Emma Burke
• Lisa Burkman, PT

• Anatomic Pathology & Clinical Pathology Physician in Maywood, IL
• Providers in Maywood, IL by specialty
• Anatomic Pathology & Clinical Pathology Physician in Illinois

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 7, 2015; 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.

Verify at the official NPI Registry.