DR. MARVIN J. DERRICK (NPI# 1497855886) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1497855886 |
| Entity Type | Individual |
| Full Name | DR. MARVIN J. DERRICK |
| Credential | M.D. |
| Practice Address |
2300 N Edward St Suite 2350 Decatur IL 62526-4163 |
| Mailing Address |
2300 N Edward St Gsbll Decatur IL 62526-4163 |
| Practice Telephone | 2178762880 |
| Practice Fax Number | 2178762885 |
| Mailing Telephone | 2178762857 |
| Mailing Fax Number | 2178762874 |
| Enumeration Date | 2006-09-25 |
| Last Update Date | 2014-11-24 |
| Gender Code | M |
| Is Sole Proprietor | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 208G00000X | Thoracic Surgery (Cardiothoracic Vascular Surgery) | 036123699 | IL | Allopathic & Osteopathic Physicians |
| N | 208G00000X | Thoracic Surgery (Cardiothoracic Vascular Surgery) | G47855 | CA | Allopathic & Osteopathic Physicians |
| Street Address |
2300 N EDWARD ST SUITE 2350 |
| City | DECATUR |
| State | IL |
| Zip Code | 62526-4163 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1104829886 | Tansel Turgut | Internal Medicine | 2300 N Edward St, Ste 2400, Decatur, IL 62526-4163 | 2005-05-24 |
| 1215538004 | Jordanna Ruth Wilton | Nurse Practitioner | 2300 N Edward St, Decatur, IL 62526-4192 | 2020-11-06 |
| 1366054116 | Stephanie Nicole Blaha | Physician Assistant | 2300 N Edward St, Decatur, IL 62526-4163 | 2020-08-21 |
| 1861028193 | Angelina Marie Thomas | Nurse Anesthetist, Certified Registered | 2300 N Edward St, Decatur, IL 62526-4163 | 2020-03-18 |
| 1114550944 | Chelsey M Clark | Nurse Anesthetist, Certified Registered | 2300 N Edward St, Decatur, IL 62526-4163 | 2020-02-20 |
| 1942857735 | Jessica Oranika | Nurse Practitioner | 2300 N Edward St, Decatur, IL 62526-4163 | 2019-08-26 |
| 1003463225 | Jason Grauer | Nurse Practitioner | 2300 N Edward St, Decatur, IL 62526-4192 | 2019-08-22 |
| 1780239434 | Maggie Kaye Matthews | Nurse Practitioner | 2300 N Edward St, Decatur, IL 62526-4163 | 2019-08-08 |
| 1871052522 | Michelle Caroline Kronmiller | Nurse Practitioner | 2300 N Edward St, Decatur, IL 62526-4163 | 2019-03-12 |
| 1013474097 | Brittney L Jeffery | Nurse Anesthetist, Certified Registered | 2300 N Edward St, Decatur, IL 62526-4163 | 2019-02-26 |
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| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1083100804 | Coalition | Non-emergency Medical Transport (VAN) | 2375 N Longwood Dr, Decatur, IL 62526 | 2018-07-04 |
| 1881116820 | Bria N Howard | Nurse's Aide | 606 E Warren St. Apt 609, Decatur, IL 62526 | 2017-07-12 |
| 1437683679 | Lutheran Child and Family Services | Foster Care Agency | 2826 N. Monroe Street, Decatur, IL 62526 | 2017-04-14 |
| 1083166326 | Whitney Miller | Pharmacist | 225 East Ash Ave, Decatur, IL 62526 | 2016-11-03 |
| 1487053369 | Central Illinois Health Associates, Inc | Preferred Provider Organization | 2300 N. Edward Street, Decatur, IL 62526 | 2014-08-18 |
| 1659787893 | Stephanie Marie Kanitsch | Obstetrics & Gynecology | 544 W Pershing Rd Ste A, Decatur, IL 62526 | 2014-07-09 |
| 1497169973 | Brian Hassinger | Audiologist-Hearing Aid Fitter | 2605 N Water St Ste 101, Decatur, IL 62526 | 2014-06-12 |
| 1891041570 | Decatur 2016 LLC | Dentist | 141 Epershing Rd, Decatur, IL 62526 | 2012-07-31 |
| 1558639005 | Larry Lee Christensen | Pharmacist | 225 Ash Ave, Decatur, IL 62526 | 2011-12-12 |
| 1174821540 | Nathan Pyle | Internal Medicine | 2 Memorial Dr Ste 101, Decatur, IL 62526 | 2011-03-08 |
| Find all providers in zip 62526 | ||||
| Taxonomy Code | 208G00000X |
| Grouping | Allopathic & Osteopathic Physicians |
| Classification | Thoracic Surgery (Cardiothoracic Vascular Surgery) |
| A thoracic surgeon provides the operative, perioperative and critical care of patients with pathologic conditions within the chest. Included is the surgical care of coronary artery disease, cancers of the lung, esophagus and chest wall, abnormalities of the trachea, abnormalities of the great vessels and heart valves, congenital anomalies, tumors of the mediastinum and diseases of the diaphragm. The management of the airway and injuries of the chest is within the scope of the specialty. |
| Notes: Source: American Board of Medical Specialties, 2007. www.abms.org [7/1/2007: definition added, source added] Additional Resources: American Board of Thoracic Surgery, 2007. http://www.abts.org/. Board certification for Medical Doctors (MDs) is provided by the American Board of Thoracic Surgery. Thoracic surgeons have the knowledge, experience and technical skills to accurately diagnose, operate upon safely, and effectively manage patients with thoracic diseases of the chest. This requires substantial knowledge of cardiorespiratory physiology and oncology, as well as capability in the use of heart assist devices, management of abnormal heart rhythms and drainage of the chest cavity, respiratory support systems, endoscopy and invasive and noninvasive diagnostic techniques. |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1174754246 | Adil Sadiq | Thoracic Surgery (Cardiothoracic Vascular Surgery) | 1036 Carlyle Lk, Decatur, GA 30033-4632 | 2009-08-06 |
| 1164751012 | Michael B Stubbs Md PC | Thoracic Surgery (Cardiothoracic Vascular Surgery) | 465 Winn Way, Suite 211, Decatur, GA 30030-1753 | 2009-12-23 |
| 1861651739 | Charles Shieh | Thoracic Surgery (Cardiothoracic Vascular Surgery) | 2675 N Decatur Rd Ste 710, Decatur, GA 30033-6135 | 2008-06-05 |
| 1417098054 | Decatur General Hospital | Thoracic Surgery (Cardiothoracic Vascular Surgery) | 1101 Somerville Rd Se, Decatur, AL 35601-3242 | 2007-02-08 |
| 1073500898 | Michael Barry Stubbs | Thoracic Surgery (Cardiothoracic Vascular Surgery) | 2675 N Decatur Rd, Ste 710, Decatur, GA 30033-6131 | 2005-10-06 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1205363041 | Sachowdhry | Thoracic Surgery (Cardiothoracic Vascular Surgery) | 1 S Summit Ave, Oakbrook Terrace, IL 60181-2212 | 2017-05-11 |
| 1760930028 | Hiroto Kitahara | Thoracic Surgery (Cardiothoracic Vascular Surgery) | 5841 S. Maryland Avenue M/c6040, Chicago, IL 60637 | 2016-09-15 |
| 1720440282 | Azad Karim | Thoracic Surgery (Cardiothoracic Vascular Surgery) | 441 E Erie St Apt 1803441, Chicago, IL 60611-4446 | 2016-03-24 |
| 1982002838 | Milton Weinberg Jr. | Thoracic Surgery (Cardiothoracic Vascular Surgery) | 983 Kirkhill Ln, Lake Forest, IL 60045-4209 | 2014-12-09 |
| 1235557190 | Bartlomiej Imielski | Thoracic Surgery (Cardiothoracic Vascular Surgery) | 201 E. Huron St., Galter 11-140, Chicago, IL 60611 | 2014-03-28 |
| 1841635869 | Aaron Maxwell Kime | Thoracic Surgery (Cardiothoracic Vascular Surgery) | 133 E Brush Hill Rd Ste 200, Elmhurst, IL 60126-5661 | 2013-05-03 |
| 1952744823 | Walter Lee Barker | Thoracic Surgery (Cardiothoracic Vascular Surgery) | 2912 N. Commonwealth Ave., #11c, Chicago, IL 60657-6235 | 2013-04-10 |
| 1952641649 | Willard A Fry | Thoracic Surgery (Cardiothoracic Vascular Surgery) | 1500 Sheridan Rd, #10e, Wilmette, IL 60091-1873 | 2013-02-18 |
| 1487903092 | Horizons In Healthcare LLC | Thoracic Surgery (Cardiothoracic Vascular Surgery) | 372 Red Bud Ct., Frankfort, IL 60423-2128 | 2012-08-29 |
| 1518215284 | Paul Naffah | Thoracic Surgery (Cardiothoracic Vascular Surgery) | 6161 So County Line Rd, Burr Ridge, IL 60527 | 2012-08-28 |
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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.