Deric J Rachjaibun, MD

Primary specialty

Family Medicine PhysicianTaxonomy code 207Q00000X

License

41861 Issued in CO

Practice address

11990 Grant St Ste 110
Northglenn, CO 80233-1122

Phone

(720) 928-0244

Fax

(720) 928-0247

NPI assigned

Sep 20, 2006

Sex

Male

Sole proprietor

No

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

Specialties & licenses 1

Addresses

Other identifiers 2

Medicare fee-for-service enrollment

Enrolled in CO

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

Credentials

Doctor of Medicine

State licenses

Practice roles

Locations

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.

• Legacy Primary Care

  • Primary Care Clinic/Center
  • Northglenn, CO
  • NPI 1841090735
  Medicare reassignment NPD Authorized official
• Deric Rachjaibun, MD LLC

  • Family Medicine Physician
  • Denver, CO
  • NPI 1497949325
  NPD (past)

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

{
    "created_epoch": "1158710400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1555977600000",
    "number": "1902903933",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "11990 GRANT ST STE 110",
            "city": "NORTHGLENN",
            "state": "CO",
            "postal_code": "802331122",
            "telephone_number": "720-928-0244",
            "fax_number": "720-928-0247"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "11990 GRANT ST STE 110",
            "city": "NORTHGLENN",
            "state": "CO",
            "postal_code": "802331122",
            "telephone_number": "720-928-0244",
            "fax_number": "720-928-0247"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "RACHJAIBUN",
        "first_name": "DERIC",
        "middle_name": "J",
        "name_prefix": "Dr.",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-09-20",
        "last_updated": "2019-04-23",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "CO",
            "license": "41861",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "57474524",
            "state": "CO"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "31930743",
            "state": "CO"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Premier Home Health Care Inc
• Lindsay Preston
• Lindsay Pruitt, LPCC
• Sunaina Puri, DDS
• Cherrie Rochelle Quintanilla
• Steven Radtke, MA, BCBA
• Jennifer Rae Rael
• Amanda Rahn
• Demi Raines, OTD
• Lorisa Rose Ramadan

• Family Medicine Physician in Northglenn, CO
• Providers in Northglenn, CO by specialty
• Family Medicine Physician in Colorado

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 23, 2019; 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.