Tia Dawn Derritt-Withers, PA-C

Primary specialty

Physician AssistantTaxonomy code 363A00000X

License

15-02637 Issued in KS

Practice address

823 SW Mulvane St
Topeka, KS 66606-1764

Phone

(785) 580-0369

Fax

(785) 354-0519

NPI assigned

May 11, 2022

Sex

Female

Sole proprietor

No

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

Specialties & licenses 1

Addresses

Other names 1

• Tia Withers Former name

Medicare fee-for-service enrollment

Enrolled in KS

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

Other, 2022

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

Cotton-O'Neil Clinic Revocable TrustGroup PAC ID 5496659195, 659 clinicians

Practice addresses (Care Compare)

Hospital & facility affiliations

• Stormont Vail Hospital Hospital, Topeka, KS, CCN 170086

Medicare enrollment (NPD)

Enrolled

State licenses

Practice roles

Locations

Interoperability endpoints

• Direct secure messaging: twithers118532@stormontvaildirect.org

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.

• Cotton-O'Neil Clinic Revocable Trust

  • Internal Medicine Physician
  • Topeka, KS
  • NPI 1811944457

  KS

  Medicare reassignment Care Compare group NPD
• Cotton-O'Neil Clinic Revocable Trust

  • Durable Medical Equipment & Medical Supplies
  • Topeka, KS
  • NPI 1700076015
  NPD

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

• Stormont-Vail Healthcare Inc

  • General Acute Care Hospital
  • Topeka, KS
  • NPI 1194782409

  Hospital

  Care Compare affiliation

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

{
    "created_epoch": "1652227200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1780358400000",
    "number": "1992441034",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "823 SW MULVANE ST",
            "city": "TOPEKA",
            "state": "KS",
            "postal_code": "666061764",
            "telephone_number": "785-580-0369",
            "fax_number": "785-354-0519"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "823 SW MULVANE ST",
            "city": "TOPEKA",
            "state": "KS",
            "postal_code": "666061764",
            "telephone_number": "785-580-0369",
            "fax_number": "785-354-0519"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "1500 SW 10th Ave",
            "address_purpose": "LOCATION",
            "city": "Topeka",
            "state": "KS",
            "postal_code": "666041301",
            "country_code": "US",
            "telephone_number": "785-354-6000",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "DERRITT-WITHERS",
        "first_name": "TIA",
        "middle_name": "DAWN",
        "credential": "PA-C",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2022-05-11",
        "last_updated": "2026-06-02",
        "certification_date": "2026-06-02",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "KS",
            "license": "15-02637",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "TIA",
            "last_name": "WITHERS",
            "code": "1",
            "type": "Former Name"
        }
    ]
}

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• All providers in Topeka, KS
• Physician Assistant in Kansas

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 2, 2026; 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.