Derald Phillips Jr., PA

Primary specialty

Medical Physician AssistantTaxonomy code 363AM0700X

License

PA12454 Issued in TX

Practice address

1901 Medi Park Dr Ste 2050
Amarillo, TX 79106-2109

Phone

(806) 355-3352

NPI assigned

Aug 17, 2018

Sex

Male

Sole proprietor

Yes

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

Specialties & licenses 2

Addresses

Medicare fee-for-service enrollment

Enrolled in TX

Eligible to order & refer

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

Green means eligible to order or refer.

Enrollment records 1

Specialty

Physician Assistant

Education

Southern Illinois University School of Medicine, 2018

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

High Plains Radiological Association LLPGroup PAC ID 9739172479, 36 clinicians

Practice addresses (Care Compare)

Hospital & facility affiliations

• Bsa Hospital Hospital, Amarillo, TX, CCN 450231

Medicare enrollment (NPD)

Enrolled

Credentials

Physician Assistant

State licenses

Interoperability endpoints

• Direct secure messaging: dphillips181930@ahs.direct-ci.com

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.

• High Plains Radiological Association LLP

  • Diagnostic Radiology Physician
  • Amarillo, TX
  • NPI 1205897360
  Medicare reassignment Care Compare group

Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.

• Bsa Hospital LLC

  • General Acute Care Hospital
  • Amarillo, TX
  • NPI 1407191984
  Care Compare affiliation

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

{
    "created_epoch": "1534464000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1557878400000",
    "number": "1972083137",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3605 PORTLAND AVE",
            "city": "AMARILLO",
            "state": "TX",
            "postal_code": "791188197",
            "telephone_number": "217-918-0207"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1901 MEDI PARK DR STE 2050",
            "city": "AMARILLO",
            "state": "TX",
            "postal_code": "791062109",
            "telephone_number": "806-355-3352"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "PHILLIPS",
        "first_name": "DERALD",
        "name_prefix": "Mr.",
        "name_suffix": "Jr.",
        "credential": "PA",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2018-08-17",
        "last_updated": "2019-05-15",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363AM0700X",
            "taxonomy_group": "",
            "desc": "Physician Assistant, Medical",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "363AM0700X",
            "taxonomy_group": "",
            "desc": "Physician Assistant, Medical",
            "state": "TX",
            "license": "PA12454",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Samantha Phelps, COTA
• Alexis Marie Phetsavanh, FNP-C
• Rachel M Philip, MD
• Angela K Phillips, RN, MSN, CS, FNP
• Angela M Phillips, PT
• Kimberli Shea Phillips, PHD, LCSW, ACHP-SW
• Noelle Phillips
• Donna Phipps, M.S., SLP
• Garrett Evan Phipps, D.D.S.
• Physical Therapy Today of Lubbock, LP

• Medical Physician Assistant in Amarillo, TX
• Providers in Amarillo, TX by specialty
• Medical Physician Assistant in Texas

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 15, 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.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.