Derrick Boyd, PA

Primary specialty

Physician AssistantTaxonomy code 363A00000X

License

MA003235L Issued in PA

Practice address

561 Fairthorne Ave.
Fairmount Behavioral Health System
Philadelphia, PA 19128

Phone

(215) 582-3405

NPI assigned

Aug 1, 2008

Sex

Male

Sole proprietor

Yes

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

Specialties & licenses 3

Addresses

Other names 1

• Mr. Derrick Boyd Professional name

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Eligible to order & refer

• Part B services: No
• Medical equipment: Yes
• Home health: No
• Power mobility devices: Yes
• Hospice: No

Green means eligible to order or refer.

Medicare enrollment (NPD)

Enrolled

Credentials

Physician Assistant

State licenses

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

{
    "created_epoch": "1217548800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1430438400000",
    "number": "1962668657",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "561 FAIRTHORNE AVE",
            "address_2": "FAIRMOUNT BEHAVIORAL HEALTH SYSTEM",
            "city": "PHILADELPHIA",
            "state": "PA",
            "postal_code": "19128",
            "fax_number": "267-582-3405"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "561 FAIRTHORNE AVE.",
            "address_2": "FAIRMOUNT BEHAVIORAL HEALTH SYSTEM",
            "city": "PHILADELPHIA",
            "state": "PA",
            "postal_code": "19128",
            "telephone_number": "215-582-3405"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "BOYD",
        "first_name": "DERRICK",
        "name_prefix": "Mr.",
        "credential": "PA",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2008-08-01",
        "last_updated": "2015-05-01",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363AM0700X",
            "taxonomy_group": "",
            "desc": "Physician Assistant, Medical",
            "state": "PA",
            "license": "MA003235L",
            "primary": false
        },
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "PA",
            "license": "MA003235L",
            "primary": true
        },
        {
            "code": "363AS0400X",
            "taxonomy_group": "",
            "desc": "Physician Assistant, Surgical",
            "state": "PA",
            "license": "MA003235L",
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "DERRICK",
            "last_name": "BOYD",
            "prefix": "MR.",
            "credential": "P.A.-C",
            "code": "2",
            "type": "Professional Name"
        }
    ]
}

• Tyler Gareth Boyce
• Alexander Boyd
• Anthony Thomas Boyd, OD
• Brandon Boyd, M.D
• Christopher Maasai Boyd, DDS
• Jazzmin Marquita Boyd, CLC
• Jeffrey M Boyd, DO
• Karla Rachel Boyd
• Mackenzie O'Brien Boyd, PA-C
• Malik Boyd

• Physician Assistant in Philadelphia, PA
• Providers in Philadelphia, PA by specialty
• Physician Assistant in Pennsylvania

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 1, 2015; 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.