DR. MICHAEL IAN DERRICK (NPI# 1275828717) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1275828717 |
| Entity Type | Individual |
| Full Name | DR. MICHAEL IAN DERRICK |
| Credential | M.D. |
| Practice Address |
2401 Gillham Rd Kansas City MO 64108-4619 |
| Mailing Address |
2401 Gillham Rd. Provider Enrollment Kansas City MO 64108-4619 |
| Practice Telephone | 8162343000 |
| Practice Fax Number | 8163029939 |
| Mailing Telephone | (816) 701-5200 |
| Mailing Fax Number | 8163029939 |
| Enumeration Date | 2011-06-13 |
| Last Update Date | 2017-08-01 |
| Gender Code | M |
| Is Sole Proprietor | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| N | 2080P0201X |
Pediatrics Specialization: Pediatric Allergy/Immunology |
04-40205 | KS | Allopathic & Osteopathic Physicians |
| Y | 2080P0201X |
Pediatrics Specialization: Pediatric Allergy/Immunology |
2017023519 | MO | Allopathic & Osteopathic Physicians |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1790133734 | Michael Derrick | Pediatrics | 1100 Reid Pkwy, Reid Hospital & Health Care Services, Richmond, IN 47374 | 2016-06-01 |
| Street Address |
2401 GILLHAM RD |
| City | KANSAS CITY |
| State | MO |
| Zip Code | 64108-4619 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1114921533 | Brent Ellis Cully | Radiology | 2401 Gillham Rd, Kansas City, MO 64108-4619 | 2005-06-13 |
| 1649878265 | Noelle Elise St. Jacques | Pediatrics | 2401 Gillham Rd, Kansas City, MO 64108-4619 | 2020-10-15 |
| 1376150243 | Casey M Bradshaw | Nurse Practitioner | 2401 Gillham Rd, Kansas City, MO 64108-4619 | 2020-09-25 |
| 1457967606 | Jennifer Coil | Nurse Practitioner | 2401 Gillham Rd, Kansas City, MO 64108-4619 | 2020-09-22 |
| 1396359923 | Kelli Nicole Ayars | Nurse Practitioner | 2401 Gillham Rd, Kansas City, MO 64108-4619 | 2020-09-01 |
| 1407460058 | Eric Bowles | Health Educator | 2401 Gillham Rd, Kansas City, MO 64108-4619 | 2020-09-01 |
| 1740892504 | Katlyn Kelley | Nurse Practitioner | 2401 Gillham Rd, Kansas City, MO 64108-4619 | 2020-08-21 |
| 1528670759 | Sarah Carstensen | Nurse Practitioner | 2401 Gillham Rd, Kansas City, MO 64108-4619 | 2020-08-19 |
| 1619588373 | Kacie E Cass | Health Educator | 2401 Gillham Rd, Kansas City, MO 64108-4619 | 2020-08-14 |
| 1932719259 | Maureen Elizabeth Guignon | Nurse Practitioner | 2401 Gillham Rd, Kansas City, MO 64108-4619 | 2020-08-01 |
| Find all providers in the same location | ||||
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1194345561 | Diversity Telehealth, LLC | Health Educator | 1601 East 18th Street, 320a, Kansas City, MO 64108 | 2020-04-25 |
| 1447894092 | Claire-louise Sophia Young | Student in an Organized Health Care Education/Training Program | Truman Medical Center - Department of Pathology, 2301 Holmes, Kansas City, MO 64108 | 2019-11-06 |
| 1053962415 | Kymberly Kline | Behavior Technician | Riley Aba & Autism Center, 1936 Summit St, Kansas City, MO 64108 | 2019-09-26 |
| 1841854643 | Mallak Ahmed Ghozlan Zatreh | Student in an Organized Health Care Education/Training Program | 2301 Homes Street, Kansas City, MO 64108 | 2019-04-26 |
| 1003470881 | Sindhuja Palle | Internal Medicine | Truman Medial Center, 2301 Holmes Dept. of Interal Medicine, Kansas City, MO 64108 | 2019-04-26 |
| 1467016253 | Osama Mahmoud Okasha | Internal Medicine | Truman Medicial Center, 2301 Holmes, Dept of Internal Medicine, Kansas City, MO 64108 | 2019-04-26 |
| 1730643719 | Michele D Smith | Registered Nurse | 2101 Charlotte Street, Urology, Kansas City, MO 64108 | 2019-01-24 |
| 1437640414 | Omar Fayez Ahmad Abuqamar | Student in an Organized Health Care Education/Training Program | Truman Medical Center, 2301 Holmes St., Dept. of Internal Medicine, Kansas City, MO 64108 | 2018-05-24 |
| 1992200190 | Hannah Rebekah Hurst | Student in an Organized Health Care Education/Training Program | 2101 Charlotte St Ste 200, Kansas City, MO 64108 | 2018-03-28 |
| 1659873404 | William Andrew Carroll | Chiropractor | 313 E. 17th St. #210, Kansas City, MO 64108 | 2018-03-07 |
| Find all providers in zip 64108 | ||||
| Taxonomy Code | 2080P0201X |
| Grouping | Allopathic & Osteopathic Physicians |
| Classification | Pediatrics |
| Specialization | Pediatric Allergy/Immunology |
| A pediatrician who specializes in the diagnosis and treatment of allergies, allergic reactions, and immunologic diseases in children. |
| Notes: Source: National Uniform Claim Committee, 2009 [1/1/2010: title modified, definition added, source added] Additional Resources: A Certification of Special Qualifications (CSQ) is issued by the American Osteopathic Board of Pediatrics. |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1073561742 | Paul Joseph Dowling Jr. | Pediatrics | 2401 Gillham Rd, Kansas City, MO 64108-4619 | 2006-05-05 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1649499401 | St Louis University | Pediatrics | 1465 S Grand Blvd, Saint Louis, MO 63104-1003 | 2007-04-24 |
| 1619993920 | Gordon R Bloomberg | Pediatrics | 1 Childrens Pl, Ste 5s30, Saint Louis, MO 63110-1002 | 2006-07-14 |
| 1821037334 | Ray S Davis | Pediatrics | 1 Childrens Pl, Saint Louis, MO 63110-1002 | 2006-06-06 |
| 1578510509 | Lisa V Suffian | Pediatrics | 1 Childrens Pl, Saint Louis, MO 63110-1002 | 2006-05-27 |
| City | KANSAS CITY |
| Zip Code | 64108 |
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| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.