Individual provider Active NPI

Christopher Charles Derenzo, M.D.

  • Pediatric Hematology & Oncology Physician
  • Memphis, TN
National Provider Identifier
1871755447
Registry record updated Apr 1, 2019
On this page

Key facts

NPPES NPI Registry
Primary specialty
Pediatric Hematology & Oncology PhysicianTaxonomy code 2080P0207X
License
57263 Issued in TN
Practice address
262 Danny Thomas PL
Memphis, TN 38105-3678
Phone
(901) 595-3300
NPI assigned
Jun 25, 2008
Sex
Male
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Apr 1, 2019

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

Specialties & licenses 3

Specialty (taxonomy)CodeLicenseStatePrimary
Pediatric Hematology & Oncology Physician 2080P0207X P9066 TX
Student in an Organized Health Care Education/Training Program 390200000X AU2866626X053 OH
Pediatric Hematology & Oncology Physician 2080P0207X 57263 TN Primary

Addresses

Primary practice location

262 Danny Thomas PL
Memphis, TN 38105-3678

Mailing address

262 Danny Thomas PL
Memphis, TN 38105-3678

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in TN
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
I20200619000925 TN Practitioner - Pediatric Medicine 5991127953 Reassigns benefits to 1 organization

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
P9066TXMDPediatric Hematology & Oncology Physician
AU2866626X053OHMDStudent in an Organized Health Care Education/Training Program

Practice roles

OrganizationSpecialtyStatusNew patients
St Jude Children'S Research Hospital, Inc. Pediatric Hematology-Oncology CurrentSince May 11, 2020 Accepting new patients
St Jude Childrens Research Hospital Inc Past Accepting new patients

Locations

262 Danny Thomas Pl
Memphis, TN 38105
Phone (888) 226-4343

262 Danny Thomas Pl
#515
Memphis, TN 38105
Phone (901) 495-3006

Interoperability endpoints

  • Direct secure messaging: cderenzo21318@stjude.direct-ci.com

Organizations & group practices 2

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": "1214352000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1554076800000",
    "number": "1871755447",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "262 DANNY THOMAS PL",
            "city": "MEMPHIS",
            "state": "TN",
            "postal_code": "381053678"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "262 DANNY THOMAS PL",
            "city": "MEMPHIS",
            "state": "TN",
            "postal_code": "381053678",
            "telephone_number": "901-595-3300"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "DERENZO",
        "first_name": "CHRISTOPHER",
        "middle_name": "CHARLES",
        "name_prefix": "Dr.",
        "credential": "M.D.",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2008-06-25",
        "last_updated": "2019-04-01",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "2080P0207X",
            "taxonomy_group": "",
            "desc": "Pediatrics, Pediatric Hematology-Oncology",
            "state": "TX",
            "license": "P9066",
            "primary": false
        },
        {
            "code": "390200000X",
            "taxonomy_group": "",
            "desc": "Student in an Organized Health Care Education/Training Program",
            "state": "OH",
            "license": "AU2866626X053",
            "primary": false
        },
        {
            "code": "2080P0207X",
            "taxonomy_group": "",
            "desc": "Pediatrics, Pediatric Hematology-Oncology",
            "state": "TN",
            "license": "57263",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Memphis, TN

Sources for this page

Verify at the official NPI Registry.