NPIMap

Organization Active NPI

Family Medcenters, P.a.

Doing business as Derby Family MedCenter

  • Family Medicine Physician
  • Derby, KS
National Provider Identifier
1982884987
Registry record updated Nov 7, 2007
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Medicine PhysicianTaxonomy code 207Q00000X
Legal business name
FAMILY MEDCENTERS, P.A.
Doing business as
Derby Family MedCenter
Practice address
1101 N Rock Rd
Derby, KS 67037-3705
Phone
(316) 788-6963
Fax
(316) 788-5373
NPI assigned
Nov 7, 2007
Last updated
Nov 7, 2007By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Nov 7, 2007

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

Authorized official

Name
David W. Niederee, M.D.
Title
President
Phone
(316) 788-6963

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Family Medicine PhysicianGroup: 193400000X SINGLE SPECIALTY GROUP 207Q00000X Primary

Addresses

Primary practice location

1101 N Rock Rd
Derby, KS 67037-3705

Mailing address

1101 N Rock Rd
Derby, KS 67037-3705
Phone (316) 788-6963

Other names 1

  • Derby Family MedCenter Doing business as

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in KS

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20100930078748 KS DME Supplier - Physician - Family Practice 4688568751 Practice locations: Derby, KS

Other NPIs with the same Medicare PAC ID 2

NPIs whose Medicare enrollments share a PECOS associate control ID (the same enrolled entity).

Laboratory certificates & supplier records

Derived by NPIMap

These CMS records do not include an NPI. They are shown because their name and street address match this provider’s.

CLIA laboratory certificates

CLIA numberLaboratoryCertificateExpires
17D0450969Derby Family Medcenter1101 North Rock Road, Derby, KS 67037AccreditationDec 9, 2027

National Provider Directory

National Provider Directory
Tax ID family
Derby Ambulatory Surgery5 organizations share this tax ID, including this one

Other organizations with this tax ID 4

Organizations that report the same tax identification number in the National Provider Directory.

Locations

307 W US Highway 54
Andover, KS 67002
Phone (316) 218-0008

1101 N Rock Rd
Derby, KS 67037
Phone (316) 788-6669

1004 SE Louis Dr
Mulvane, KS 67110
Phone (316) 777-0176

Practitioners & affiliated clinicians

Practitioners 8

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

NPI Registry JSON

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

{
    "created_epoch": "1194393600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1194393600000",
    "number": "1982884987",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1101 N ROCK RD",
            "city": "DERBY",
            "state": "KS",
            "postal_code": "670373705",
            "telephone_number": "316-788-6963",
            "fax_number": "316-788-5373"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1101 N ROCK RD",
            "city": "DERBY",
            "state": "KS",
            "postal_code": "670373705",
            "telephone_number": "316-788-6963",
            "fax_number": "316-788-5373"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "FAMILY MEDCENTERS, P.A.",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-11-07",
        "last_updated": "2007-11-07",
        "status": "A",
        "authorized_official_last_name": "NIEDEREE",
        "authorized_official_first_name": "DAVID",
        "authorized_official_middle_name": "W.",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "316-788-6963",
        "authorized_official_credential": "M.D."
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Family Medicine",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Derby Family MedCenter",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Derby, KS

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 7, 2007; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • 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.