JAMES LYLE DERICKSON (NPI# 1023035524) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1023035524 |
| Entity Type | Individual |
| Full Name | JAMES LYLE DERICKSON |
| Credential | MD |
| Practice Address |
1852 N Mastick Way Nogales AZ 85621 |
| Mailing Address |
825 N Grand Ave Ste 100 Nogales AZ 85621-1061 |
| Practice Telephone | 5202811550 |
| Practice Fax Number | 5202814487 |
| Mailing Telephone | 5207612133 |
| Mailing Fax Number | 5202812335 |
| Enumeration Date | 2006-07-17 |
| Last Update Date | 2018-11-28 |
| Gender Code | M |
| Is Sole Proprietor | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 207Q00000X | Family Medicine | 37067 | AZ | Allopathic & Osteopathic Physicians |
| State | Issuer | Identifier | Type Code |
|---|---|---|---|
| AZ | 266946 | 05 |
| Address | Telephone Number | Fax Number |
|---|---|---|
| 1260 S Campbell Rd, Building 2, Green Valley, AZ 856142666 | 5204075800 | 5204075990 |
| Street Address |
1852 N MASTICK WAY |
| City | NOGALES |
| State | AZ |
| Zip Code | 85621 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1053393298 | Valerie A Wohl | Family Medicine | 1852 N Mastick Way, Nogales, AZ 85621-1063 | 2005-11-15 |
| 1205450046 | Vincent Tsang | Pharmacist | 1852 N Mastick Way, Nogales, AZ 85621-1063 | 2020-06-06 |
| 1326524083 | Sonia I Guerrero | Registered Nurse | 1852 N Mastick Way, Nogales, AZ 85621-1061 | 2018-07-16 |
| 1891222105 | Kacy Novotny | Nurse Practitioner | 1852 N Mastick Way, Nogales, AZ 85621-1063 | 2017-05-17 |
| 1437507654 | Jorge Omar Flores Lopez | Internal Medicine | 1852 N Mastick Way, Nogales, AZ 85621-1063 | 2016-05-27 |
| 1740663509 | Marivic Ashcroft | Nurse Practitioner | 1852 N Mastick Way, Nogales, AZ 85621-1063 | 2015-06-29 |
| 1487041216 | Mary Carmen Garcia-kumirov | Family Medicine | 1852 N Mastick Way, Nogales, AZ 85621 | 2015-04-20 |
| 1619365954 | Greta Liz Lopez | Nurse Practitioner | 1852 N Mastick Way, Nogales, AZ 85621-1063 | 2015-01-08 |
| 1861804452 | Crystalynn Woodard | Obstetrics & Gynecology | 1852 N Mastick Way, Nogales, AZ 85621 | 2014-05-29 |
| 1962813352 | Nourhan Mustafa | Obstetrics & Gynecology | 1852 N Mastick Way, Nogales, AZ 85621-1063 | 2014-05-19 |
| Find all providers in the same location | ||||
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1548771033 | Intermountain Health Center, Inc. | Community/Behavioral Health | 272 West Viewpoint Drive, Nogales, AZ 85621 | 2017-10-24 |
| 1336696657 | Intermountain Centers for Human Development Inc. | Community/Behavioral Health | 276 West View Point Drive, Nogales, AZ 85621 | 2016-09-02 |
| 1831584291 | Helping Ourselves Pursue Enrichment, Inc. | Community/Behavioral Health | 1857 N Mastick Way, Nogales, AZ 85621 | 2015-04-02 |
| 1043504376 | Community Intervention Associates | Community/Behavioral Health | 32 Blvd Del Rey David, Nogales, AZ 85621 | 2011-06-03 |
| 1568782175 | Arizona's Children Association | Clinic/Center | 1740 N. Mastick Way, Suite D, Nogales, AZ 85621 | 2010-06-04 |
| 1811032493 | Susan M. Jaworski | Local Education Agency (LEA) | 315 Plum Street, Nogales, AZ 85621 | 2007-02-21 |
| 1194885905 | Alex Gracia | Pharmacy Technician | 839 W. Calle Chico, Nogales, AZ 85621 | 2006-12-11 |
| 1982716130 | Yvette Denise Braun | Chiropractor | 1821 N Mastick Way #1, Nogales, AZ 85621 | 2006-08-31 |
| 1043254154 | John Diaz | Emergency Medicine | 1171 W Target Range Road, Carondelet Holy Cross Hospital, Nogales, AZ 85621 | 2006-06-16 |
| 1467495085 | Bart L Mc Rae | Emergency Medicine | Carondelet Holy Cross Hospital, 1171 W. Target Range Road, Nogales, AZ 85621 | 2006-06-13 |
| Find all providers in zip 85621 | ||||
| Taxonomy Code | 207Q00000X |
| Grouping | Allopathic & Osteopathic Physicians |
| Classification | Family Medicine |
| Family Medicine is the medical specialty which is concerned with the total health care of the individual and the family. It is the specialty in breadth which integrates the biological, clinical, and behavioral sciences. The scope of family medicine is not limited by age, sex, organ system, or disease entity. |
| Notes: Source: American Board of Family Medicine [1/1/2007: changed title; 7/1/2007: added definition, added source; 7/1/2017: modified definition] - Note: The American Osteopathic Board of Family Physicians certification includes extensive use of Osteopathic Manipulative Treatment (OMT), which integrates the biological, clinical, and behavioral sciences. - Additional Resources: American Board of Family Medicine, www.theabfm.org. American Osteopathic Board of Family Physicians, www.osteopathic.org/certification - Board certification for Medical Doctors (MDs) is provided by the American Board of Family Medicine. Board certification for Doctors of Osteopathy (DOs) is provided by the American Osteopathic Board of Family Physicians or the American Board of Family Medicine. |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1053393298 | Valerie A Wohl | Family Medicine | 1852 N Mastick Way, Nogales, AZ 85621-1063 | 2005-11-15 |
| 1285626754 | William Lester Bartholomew | Family Medicine | 1171 W Target Range Rd, Nogales, AZ 85621-2415 | 2005-08-19 |
| 1013523539 | Mariposa Community Health Center | Family Medicine | 1209 W Target Range Rd, Nogales, AZ 85621-2466 | 2020-09-21 |
| 1487041216 | Mary Carmen Garcia-kumirov | Family Medicine | 1852 N Mastick Way, Nogales, AZ 85621 | 2015-04-20 |
| 1922418979 | Jared Ryan Lunkenheimer | Family Medicine | 1209 W Target Range Rd, Nogales, AZ 85621-2466 | 2014-04-29 |
| 1275893729 | Rosa Isela Machado | Family Medicine | 1852 N Mastick Way, Nogales, AZ 85621-1063 | 2012-05-17 |
| 1801123948 | Jeffrey Lynn Courville | Family Medicine | 1852 N Mastick Way, Nogales, AZ 85621-1063 | 2009-11-10 |
| 1659468650 | Margie M Hartfield | Family Medicine | 1852 N Mastick Way, Nogales, AZ 85621-1063 | 2006-10-10 |
| 1811930423 | Jeffrey Thomas Maudlin | Family Medicine | 1209 W Target Range Rd, Nogales, AZ 85621-2466 | 2006-06-13 |
| 1669449187 | Carmelo Alfonzo Echeverria | Family Medicine | 1852 N Mastick Way, Nogales, AZ 85621-1063 | 2006-03-02 |
| Find all providers in NOGALES | ||||
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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.