DR. DEREK PAUL DE GRIJS (NPI# 1275893638) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1275893638 |
| Entity Type | Individual |
| Full Name | DR. DEREK PAUL DE GRIJS |
| Credential | M.D. |
| Practice Address |
501 Marshall St Ste 104 Jackson MS 39202-1663 |
| Mailing Address |
100 W California Blvd Pasadena CA 91105-3010 |
| Practice Telephone | 6019696404 |
| Practice Fax Number | 6019734541 |
| Enumeration Date | 2012-05-20 |
| Last Update Date | 2019-07-09 |
| Gender Code | M |
| Is Sole Proprietor | Y |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 2086S0129X |
Surgery Specialization: Vascular Surgery |
26892 | MS | Allopathic & Osteopathic Physicians |
| Address | Telephone Number | Fax Number |
|---|---|---|
| 100 W California Blvd, Pasadena, CA 911053010 | 6263975000 | |
| 501 Marshall St Ste 104, Jackson, MS 392021663 | 6019696404 | 6019734541 |
| Street Address |
501 MARSHALL ST STE 104 |
| City | JACKSON |
| State | MS |
| Zip Code | 39202-1663 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1578557013 | Frank Nelson Haugland | Internal Medicine | 501 Marshall St Ste 104, Jackson, MS 39202-1663 | 2005-09-09 |
| 1760956247 | Siera Cheyenne Shiyou | Physician Assistant | 501 Marshall St Ste 104, Jackson, MS 39202 | 2019-01-17 |
| 1346751195 | Amy Wall | Nurse Practitioner | 501 Marshall St Ste 104, Jackson, MS 39202-1663 | 2017-10-19 |
| 1578946612 | Katherine Tucker | Physician Assistant | 501 Marshall St Ste 104, Jackson, MS 39202-1663 | 2015-07-07 |
| 1811396971 | Rachel P Hearst | Nurse Practitioner | 501 Marshall St Ste 104, Jackson, MS 39202-1663 | 2014-08-14 |
| 1902235583 | Judith Stallings | Nurse Practitioner | 501 Marshall St Ste 104, Jackson, MS 39202-1663 | 2013-11-05 |
| 1508206913 | Stephen David Anderson | Internal Medicine | 501 Marshall St Ste 104, Jackson, MS 39202-1663 | 2013-06-28 |
| 1205178241 | Shanna Amisha Tolbert Craven | Nurse Practitioner | 501 Marshall St Ste 104, Jackson, MS 39202-1663 | 2013-03-16 |
| 1275897670 | Patrick Ross Thurmond | Internal Medicine | 501 Marshall St Ste 104, Jackson, MS 39202-1663 | 2012-06-29 |
| 1215249016 | Rishi Ashok Roy | Surgery | 501 Marshall St Ste 104, Jackson, MS 39202-1663 | 2010-07-08 |
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| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1982234183 | Eva Mackenzie Carmody | Physician Assistant | 1190 N State St Suite 502, Jackson, MS 39202 | 2020-01-16 |
| 1750868691 | Katherine Walters | Nurse Practitioner | 501 Marshall St., Suite 400, Jackson, MS 39202 | 2018-07-24 |
| 1932638749 | Tylan Lee | Social Worker | 860 East River Place Suite 100, Jackson, MS 39202 | 2017-06-06 |
| 1417314725 | Euna Jyles | Counselor | 860 E River Pl, Jackson, MS 39202 | 2016-01-19 |
| 1255712048 | Edward Jonathan Breight | Specialist/Technologist | 1325 East Fortication Street, Jackson, MS 39202 | 2015-06-17 |
| 1881037703 | Kara Spinks Logan | Surgery | 1190 N State St Ste 502, Jackson, MS 39202 | 2013-04-10 |
| 1477876530 | Mick Inc. | Technician | 334 Josanna Street, Suite #209, Jackson, MS 39202 | 2010-03-03 |
| 1073724910 | Paul Frederic Dare | Anesthesiology | 1151 North State St., Suite 311, Jackson Anesthesia Associates, Jackson, MS 39202 | 2007-05-24 |
| 1225247703 | Lynn Kincannon Holland | Counselor | 911 Manship Street, Unit A, Jackson, MS 39202 | 2007-05-22 |
| 1457568149 | Incare Inc | Pulmonary Function Technologist | 1151 North State St, Suite 406, Jackson, MS 39202 | 2007-05-16 |
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| Taxonomy Code | 2086S0129X |
| Grouping | Allopathic & Osteopathic Physicians |
| Classification | Surgery |
| Specialization | Vascular Surgery |
| A surgeon with expertise in the management of surgical disorders of the blood vessels, excluding the intracranial vessels or the heart. |
| Notes: Source: American Board of Medical Specialties, 2007. www.abms.org [7/1/2007: definition added, source added; 7/1/2011: modified source] - Additional Resources: American Board of Surgery, 2007. http://www.absurgery.org/. American Osteopathic Board of Surgery, 2007. http://www.osteopathic.org/certification - Board certification for Medical Doctors (MDs) is provided by the American Board of Surgery. Board certification for Doctors of Osteopathy (DOs) is provided by the American Osteopathic Board of Surgery. |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1952557092 | Medical Foundation of Central Mississippi, Inc | Surgery | 501 Marshall St Ste 100, Jackson, MS 39202-1687 | 2008-08-08 |
| 1174556377 | Seshadri Raju, M.d., Pa. | Surgery | 971 Lakeland Dr Ste 401, Jackson, MS 39216 | 2006-07-09 |
| 1225575186 | W.a. Foote Memorial Hospital, Inc | Surgery | 205 N. East Ave, Jackson, MI 49201 | 2017-01-30 |
| 1124565098 | W.a. Foote Memorial Hospital, Inc | Surgery | 205 N. East Ave, Jackson, MI 49201 | 2017-01-30 |
| 1184911612 | Taimur Saleem | Surgery | 971 Lakeland Dr Ste 401, Jackson, MS 39216-4607 | 2011-07-05 |
| 1245545383 | Danon Eugenio Garrido Montes De Oca | Surgery | 2500 N State St, Jackson, MS 39216-4500 | 2010-08-12 |
| 1194825323 | Fred Wallace Rushton Jr. | Surgery | 2500 N State St, Jackson, MS 39216-4500 | 2006-09-25 |
| 1215960414 | Seshadri Raju | Surgery | 971 Lakeland Dr, Suite 401, Jackson, MS 39216-4643 | 2006-07-09 |
| 1437135373 | Anthony Bradley Boland | Surgery | 2500 N State St, Jackson, MS 39216-4500 | 2005-12-22 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1104323534 | Best Vein Care of Mississippi, LLC | Surgery | 204 W Jackson St Ste A, Ridgeland, MS 39157-2310 | 2018-04-11 |
| 1457714172 | Flowood Medical Management LLC | Surgery | 4800 Lakeland Dr, Flowood, MS 39232-8694 | 2016-03-30 |
| 1982009031 | Magnolia General and Vascular Surgery Clinic | Surgery | 611 Alcorn Dr Ste 210, Corinth, MS 38834-9323 | 2014-10-31 |
| 1730406729 | Alexander H. Nguyen | Surgery | 4503 M St, Biloxi, MS 39530 | 2010-04-29 |
| 1730243064 | Frank A Nichols | Surgery | 1040 A So Madison, Tupelo, MS 38801 | 2006-12-21 |
| 1427073386 | Edward E Rigdon | Surgery | 348 Crossgates Blvd, Suite 2500, Brandon, MS 39042-2700 | 2006-07-13 |
| 1790760692 | Surgery Associates Pa | Surgery | 440 Pegram Dr, Tupelo, MS 38801-6319 | 2005-12-13 |
| 1396226791 | North Mississippi Medical Center, Inc | Surgery | 616 Alcorn Dr, Corinth, MS 38834-9393 | 2018-08-23 |
| 1962952689 | Capel Vascular Center, LLC | Surgery | 408 E Washington St, Greenwood, MS 38930-4539 | 2016-10-05 |
| 1104101575 | North Mississippi Medical Center Services, LLC | Surgery | 607 Garfield St, Tupelo, MS 38801-6337 | 2011-10-18 |
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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.