Active NPI
Derick Dermatology, PLLC
- Dermatology Physician
- McHenry, IL
National Provider Identifier
1891283669
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Dermatology Physician
- License
- 36112935
- Legal business name
- DERICK DERMATOLOGY, PLLC
- Practice address
- 353 Bank Dr Ste 400
McHenry, IL 60050-0506 - Phone
- (847) 381-8899
- Fax
- (847) 381-8999
- NPI assigned
- Apr 27, 2018
- Last updated
- Sep 9, 2022
- Organization subpart
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Authorized official
- Name
- Amy Derick, M.D.
- Title
- Medical Director
- Phone
- (847) 381-8899
Authorized official NPPES reports the official by name only. The link goes to the one practitioner with that name whose NPPES practice address or phone number is this organization’s.
Specialties & licenses 2
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Dermatology Physician | 207N00000X | 36112935 | IL | Primary |
| Non-Pharmacy Dispensing Site | 332900000X |
Addresses
Primary practice location
353 Bank Dr Ste 400
McHenry, IL 60050-0506
Mailing address
PO Box 6685
Carol Stream, IL 60197-6685
Phone (847) 381-8899
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Enrolled in IL
Enrollment records 1
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| O20060922000130 | IL | Part B Supplier - Clinic/Group Practice | 1557366796 |
Receives reassigned benefits from 60 practitioners 18 other NPIs on this enrollment This NPI is an additional NPI on the enrollment Practice locations: Plainfield, IL; Arlington Heights, IL; Skokie, IL; Orland Park, IL; Oak Park, IL; Oak Brook, IL; Northbrook, IL; Naperville, IL… |
Other NPIs on the same Medicare enrollment 18
NPIs listed together on one Medicare enrollment, typically parts of the same organization.
Laboratory certificates & supplier records
Derived by NPIMapThese CMS records do not include an NPI. They are shown because their name and street address match this provider’s.
CLIA laboratory certificates
| CLIA number | Laboratory | Certificate | Expires |
|---|---|---|---|
| 14D2155444 | Derick Dermatology | Certificate of waiver | Sep 27, 2026 |
National Provider Directory
National Provider DirectoryLocations
1531 S Grove Ave
Unit 101
Barrington, IL 60010
Practitioners & affiliated clinicians
Practitioners 3
Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.
-
- Dermatology Physician
- Barrington, IL
- NPI 1245279884
-
- Family Nurse Practitioner
- Elgin, IL
- NPI 1598218125
-
- Physician Assistant
- Barrington, IL
- NPI 1376067736
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1524787200000",
"enumeration_type": "NPI-2",
"last_updated_epoch": "1662681600000",
"number": "1891283669",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "PO BOX 6685",
"city": "CAROL STREAM",
"state": "IL",
"postal_code": "601976685",
"telephone_number": "847-381-8899",
"fax_number": "847-381-8999"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "353 BANK DR STE 400",
"city": "MCHENRY",
"state": "IL",
"postal_code": "600500506",
"telephone_number": "847-381-8899",
"fax_number": "847-381-8999"
}
],
"practiceLocations": [],
"basic": {
"organization_name": "DERICK DERMATOLOGY, PLLC",
"organizational_subpart": "NO",
"enumeration_date": "2018-04-27",
"last_updated": "2022-09-09",
"certification_date": "2022-09-09",
"status": "A",
"authorized_official_last_name": "DERICK",
"authorized_official_first_name": "AMY",
"authorized_official_title_or_position": "MEDICAL DIRECTOR",
"authorized_official_telephone_number": "847-381-8899",
"authorized_official_credential": "M.D."
},
"taxonomies": [
{
"code": "207N00000X",
"taxonomy_group": "193400000X SINGLE SPECIALTY GROUP",
"desc": "Dermatology",
"state": "IL",
"license": "36112935",
"primary": true
},
{
"code": "332900000X",
"taxonomy_group": "",
"desc": "Non-Pharmacy Dispensing Site",
"state": null,
"license": null,
"primary": false
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in McHenry, IL
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 9, 2022; 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.