Active NPI
Derrick L Latos, M.D.
- Nephrology Physician
- Wheeling, WV
National Provider Identifier
1962463273
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Nephrology Physician
- License
- 10953
- Practice address
- 58 16TH St
Suite 500
Wheeling, WV 26003-3660 - Phone
- (304) 242-7751
- Fax
- (304) 242-7254
- NPI assigned
- Mar 29, 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 2
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Nephrology Physician | 207RN0300X | 10953 | WV | Primary |
| Nephrology Physician | 207RN0300X | 35051747L | OH |
Addresses
Primary practice location
58 16TH St
Suite 500
Wheeling, WV 26003-3660
Mailing address
58 16TH St
Suite 500
Wheeling, WV 26003-3660
Phone (304) 242-7751
Other identifiers 3
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 10953B | Other | WV | HPUOV |
| 0344854 | Medicaid | OH | |
| 0077242000 | Medicaid | WV |
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)
- Enrolled
- Credentials
- Doctor of Medicine
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 35051747L | OH | MD | Nephrology Physician |
| 10953 | WV | MD | Nephrology Physician |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Wheeling Renal Care LLC | Past | Accepting new patients |
Organizations & group practices 1
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.
-
- End-Stage Renal Disease (ESRD) Treatment Clinic/Center
- New Martinsville, WV
- NPI 1073519369
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1143590400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1204761600000",
"number": "1962463273",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "58 16TH ST",
"address_2": "SUITE 500",
"city": "WHEELING",
"state": "WV",
"postal_code": "260033660",
"telephone_number": "304-242-7751",
"fax_number": "304-242-7254"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "58 16TH ST",
"address_2": "SUITE 500",
"city": "WHEELING",
"state": "WV",
"postal_code": "260033660",
"telephone_number": "304-242-7751",
"fax_number": "304-242-7254"
}
],
"practiceLocations": [],
"basic": {
"last_name": "LATOS",
"first_name": "DERRICK",
"middle_name": "L",
"credential": "M.D.",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2006-03-29",
"last_updated": "2008-03-06",
"status": "A"
},
"taxonomies": [
{
"code": "207RN0300X",
"taxonomy_group": "",
"desc": "Internal Medicine, Nephrology",
"state": "WV",
"license": "10953",
"primary": true
},
{
"code": "207RN0300X",
"taxonomy_group": "",
"desc": "Internal Medicine, Nephrology",
"state": "OH",
"license": "35051747L",
"primary": false
}
],
"identifiers": [
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "HPUOV",
"identifier": "10953B",
"state": "WV"
},
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "0344854",
"state": "OH"
},
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "0077242000",
"state": "WV"
}
],
"endpoints": [],
"other_names": []
}Other providers in Wheeling, WV
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 6, 2008; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.