Martin A Derusha, DO

Primary specialty

Emergency Medicine PhysicianTaxonomy code 207P00000X

License

K0454 Issued in TX

Practice address

1506 Pennsylvania Ave
Fort Worth, TX 76104-2027

Phone

(817) 882-0984

Fax

(817) 882-9978

NPI assigned

Jun 3, 2006

Sex

Male

Sole proprietor

Yes

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

Specialties & licenses 1

Addresses

Other identifiers 1

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Osteopathy, Doctor of Medicine

State licenses

Practice roles

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.

• East Texas Medical Center Healthcare Associates

  • Emergency Medicine Physician
  • Tyler, TX
  • NPI 1326082892
  NPD (past)
• Houston Emergency Medicine Associates PA

  • Emergency Medicine Physician
  • Crockett, TX
  • NPI 1316976038
  NPD (past)
• Jeffrey D Rettig DO PA

  • Family Medicine Physician
  • Groesbeck, TX
  • NPI 1063680619
  NPD (past)
• Shelby Emergency Medicine Associates, PA

  • Emergency Medicine Physician
  • Center, TX
  • NPI 1063522399
  NPD (past)

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

{
    "created_epoch": "1149292800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1678147200000",
    "number": "1922046507",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1506 PENNSYLVANIA AVE",
            "city": "FORT WORTH",
            "state": "TX",
            "postal_code": "761042027",
            "telephone_number": "817-882-0984",
            "fax_number": "817-882-9978"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1506 PENNSYLVANIA AVE",
            "city": "FORT WORTH",
            "state": "TX",
            "postal_code": "761042027",
            "telephone_number": "817-882-0984",
            "fax_number": "817-882-9978"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "DERUSHA",
        "first_name": "MARTIN",
        "middle_name": "A",
        "credential": "DO",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2006-06-03",
        "last_updated": "2023-03-07",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207P00000X",
            "taxonomy_group": "",
            "desc": "Emergency Medicine",
            "state": "TX",
            "license": "K0454",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "DPS",
            "identifier": "H0101698",
            "state": "TX"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Maya Derhake, MS, CGC
• John Derouin Jr.
• Dustin Clifton Derrick, M.D.
• Tiffany Ann Derrick, LPC-I
• Alicia Denee Derry, O.D.
• Mina Girgis Deryas
• Alap Desai, M.D.
• Mita Desai, DDS
• Neal Ashok Desai, M.D.
• Parth Desai, DDS

• Emergency Medicine Physician in Fort Worth, TX
• Providers in Fort Worth, TX by specialty
• Emergency Medicine Physician in Texas

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

Verify at the official NPI Registry.