Active NPI
James L Derrico, DDS, LLC
- Dentist
- Jackson, WY
National Provider Identifier
1891801585
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Dentist
- License
- 1509
- Practice address
- 1130 S Hwy 89
Jackson, WY 83001-8512 - Phone
- (307) 200-6644
- NPI assigned
- Aug 22, 2006
- Sex
- Male
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Dentist | 122300000X | 1509 | WY | Primary |
Addresses
Primary practice location
1130 S Hwy 89
Jackson, WY 83001-8512
Mailing address
PO Box 806
Jackson, WY 83001-0806
Phone (630) 399-7367
Other practice location 1
1130 S Hwy 89
Jackson, WY 83001-8512
Phone (307) 200-6644
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
- HHS exclusion list flag
- Flagged The directory lists this NPI on an HHS exclusion list.
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 1509 | WY | MD | Geriatric Physical Therapist |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| James L. Derrico DDS LLC | Current | Accepting new patients | |
| James L Derrico DDS | Dentist | Past | Accepting new patients |
| College Square Dental | General Practice | Past | Accepting new patients |
Organizations & group practices 3
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.
-
- Customized Equipment (DME)
- Jackson, WY
- NPI 1235700014
-
- Dentist
- Lisle, IL
- NPI 1144604224
-
- General Practice Dentistry
- Lisle, IL
- NPI 1760665442
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1156204800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1683417600000",
"number": "1891801585",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "PO BOX 806",
"city": "JACKSON",
"state": "WY",
"postal_code": "830010806",
"telephone_number": "630-399-7367"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1130 S HWY 89",
"city": "JACKSON",
"state": "WY",
"postal_code": "830018512",
"telephone_number": "307-200-6644"
}
],
"practiceLocations": [
{
"address_1": "1130 S Hwy 89",
"address_purpose": "LOCATION",
"city": "Jackson",
"state": "WY",
"postal_code": "830018512",
"country_code": "US",
"telephone_number": "307-200-6644",
"country_name": "United States",
"address_type": "DOM"
}
],
"basic": {
"last_name": "DERRICO",
"first_name": "JAMES",
"middle_name": "L",
"credential": "DDS, LLC",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2006-08-22",
"last_updated": "2023-05-07",
"certification_date": "2023-05-07",
"status": "A"
},
"taxonomies": [
{
"code": "122300000X",
"taxonomy_group": "",
"desc": "Dentist",
"state": "WY",
"license": "1509",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Jackson, WY
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 7, 2023; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.