James A. Derksen, MD

Primary specialty

Family Medicine PhysicianTaxonomy code 207Q00000X

License

35053994D Issued in OH

Practice address

3080 Ackerman Blvd Ste 210
Dayton, OH 45429-3658

Phone

(937) 534-4201

Fax

(937) 291-6941

NPI assigned

Apr 13, 2006

Last updated

Feb 6, 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 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 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, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

• Premier Integrated Medical Assoc LTD

  dba PriMed Physicians

  • Family Medicine Physician
  • Dayton, OH
  • NPI 1982660189
  NPD (past)
• Premier Integrated Medical Associates, LTD

  dba PriMed Physicians

  • Cardiovascular Disease Physician
  • Kettering, OH
  • NPI 1043277437
  NPD (past)

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

{
    "created_epoch": "1144886400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1675641600000",
    "number": "1932163409",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3080 ACKERMAN BLVD STE 210",
            "city": "DAYTON",
            "state": "OH",
            "postal_code": "454293658",
            "telephone_number": "937-534-4201",
            "fax_number": "937-291-6941"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3080 ACKERMAN BLVD STE 210",
            "city": "DAYTON",
            "state": "OH",
            "postal_code": "454293658",
            "telephone_number": "937-534-4201",
            "fax_number": "937-291-6941"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "DERKSEN",
        "first_name": "JAMES",
        "middle_name": "A.",
        "name_prefix": "Dr.",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-04-13",
        "last_updated": "2023-02-06",
        "certification_date": "2023-02-06",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "OH",
            "license": "35053994D",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "0631089",
            "state": "OH"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Kent Andrew Depue, MD
• Leyla Dereci, DO
• Carly Anne Deremo, PSYD
• Bethany Joel Derhodes, M.D.
• Byron K Derksen, LPN
• Dermatologists of Southwestern Ohio, LLC. (Dermatologists of Southwest Ohio, LLC)
• Dermatology Associates of Ohio, LLC
• Dermatopathology Laboratory of Central States
• Kathleen Sarah Derr, PA-C
• Kelyea S Derricks-Linder, CPT

• Family Medicine Physician in Dayton, OH
• Providers in Dayton, OH by specialty
• Family Medicine Physician in Ohio

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 6, 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.