Derby Derm

Primary specialty

Physician AssistantTaxonomy code 363A00000X

License

1500761 Issued in KS

Legal business name

DERBY DERM

Practice address

1121 N College Park St
Suite # 400
Derby, KS 67037-3665

Phone

(316) 788-3376

Fax

(316) 788-3378

NPI assigned

Jan 31, 2008

Organization subpart

No

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

Authorized official

Name

Mr. Tim Weide, P.A.

Title

President

Phone

(316) 788-3376

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Enrolled in KS

Enrollment records 1

These CMS records do not include an NPI. They are shown because their name and street address match this provider’s.

CLIA laboratory certificates

Locations

Practitioners 3

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

• Lori E Falcone, APRN

  • Nurse Practitioner
  • Derby, KS
  • NPI 1023615648

  KS

  Medicare reassignment Care Compare group NPD
• Timothy L. Weide, P.A.

  • Physician Assistant
  • Derby, KS
  • NPI 1861600017

  KS

  Medicare reassignment Care Compare group
• Jennifer T Allen, APRN

  • Family Nurse Practitioner
  • Derby, KS
  • NPI 1326986373

  KS, Single Specialty

  Medicare reassignment NPD

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

{
    "created_epoch": "1201737600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1201737600000",
    "number": "1871771998",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1121 N COLLEGE PARK ST",
            "address_2": "SUITE # 400",
            "city": "DERBY",
            "state": "KS",
            "postal_code": "670373665",
            "telephone_number": "316-788-3376",
            "fax_number": "316-788-3378"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1121 N COLLEGE PARK ST",
            "address_2": "SUITE # 400",
            "city": "DERBY",
            "state": "KS",
            "postal_code": "670373665",
            "telephone_number": "316-788-3376",
            "fax_number": "316-788-3378"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "DERBY DERM",
        "organizational_subpart": "NO",
        "enumeration_date": "2008-01-31",
        "last_updated": "2008-01-31",
        "status": "A",
        "authorized_official_last_name": "WEIDE",
        "authorized_official_first_name": "TIM",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "316-788-3376",
        "authorized_official_name_prefix": "Mr.",
        "authorized_official_credential": "P.A."
    },
    "taxonomies": [
        {
            "code": "363A00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Physician Assistant",
            "state": "KS",
            "license": "1500761",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Gillian Darlene Delano, LMSW
• Dennis C. McAllister, DDS, PA
• Dental Professionals LLC
• Kelsey Elizabeth Depew
• Derby Assisted Living, LLC
• Derby Emotional Wellness
• Derby Eyecare LLC
• Derby Health & Rehabilitation
• Derby Modern Dentistry, PA
• Derby Recovery Center, Inc

• All providers in Derby, KS
• Physician Assistant in Kansas

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 31, 2008; 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.