Pierce Derico

Primary specialty

Family Medicine PhysicianTaxonomy code 207Q00000X

License

0101273114 Issued in VA

Practice address

1145 Sturgis Road
Twentynine Palms, CA 92278-8275

Phone

(760) 830-2117

NPI assigned

Mar 25, 2020

Last updated

Jul 3, 2023By the provider in NPPES

Sex

Male

Sole proprietor

No

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

Specialties & licenses 2

Addresses

Medicare fee-for-service enrollment

Enrolled in VA

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

Medicare enrollment (NPD)

Enrolled

State licenses

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

{
    "created_epoch": "1585094400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1688342400000",
    "number": "1891322269",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1145 STURGIS ROAD",
            "city": "TWENTYNINE PALMS",
            "state": "CA",
            "postal_code": "92278",
            "telephone_number": "760-830-2117"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1145 STURGIS ROAD",
            "city": "TWENTYNINE PALMS",
            "state": "CA",
            "postal_code": "922788275",
            "telephone_number": "760-830-2117"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "DERICO",
        "first_name": "PIERCE",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2020-03-25",
        "last_updated": "2023-07-03",
        "certification_date": "2023-06-22",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "VA",
            "license": "0101273114",
            "primary": true
        },
        {
            "code": "171000000X",
            "taxonomy_group": "",
            "desc": "Military Health Care Provider",
            "state": "NU",
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Sarah Danser, COTA
• Kannitha Makayla-Lee Davila, BA, BS
• James Elbert Davis, AU.D.
• Ada Chelan Dee, APRN
• Brianna Danielle Dennison
• Garrett Dewolf, DMD
• Jacquelynn J Diaz
• Jennifer Diemart, M.A.
• Divergent Pathways Psychological Services, Inc.
• Casey Grace Dixon, PA-C

• Family Medicine Physician in Twentynine Palms, CA
• Providers in Twentynine Palms, CA by specialty
• Family Medicine Physician in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 3, 2023; 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.