DEREK THOMAS HANSEN (NPI# 1194089581) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1194089581 |
| Entity Type | Individual |
| Full Name | DEREK THOMAS HANSEN |
| Credential | M.D. |
| Practice Address |
2500 N State St Deparment of Medicine Jackson MS 39216 |
| Mailing Address |
1324 Lakeland Hills Blvd. Attn: Managed Care Dept. Lakeland FL 33805 |
| Practice Telephone | 6019845601 |
| Practice Fax Number | 6019846665 |
| Enumeration Date | 2012-06-29 |
| Last Update Date | 2018-07-02 |
| Gender Code | M |
| Is Sole Proprietor | Y |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| N | 207R00000X | Internal Medicine | 856-L | MS | Allopathic & Osteopathic Physicians |
| Y | 207RC0200X |
Internal Medicine Specialization: Critical Care Medicine |
ME135265 | FL | Allopathic & Osteopathic Physicians |
| State | Issuer | Identifier | Type Code |
|---|---|---|---|
| MS | TEMPORARY STATE MEDICAL LICENSE | 856-L | 01 |
| Address | Telephone Number | Fax Number |
|---|---|---|
| 2500 N State St, Deparment of Medicine, Jackson, MS 392164500 | 6019845601 | 6019846665 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1194330043 | Derek Hansen | Physical Therapist | 1132 Leland Ave, Tulare, CA 93274-7811 | 2020-09-08 |
| 1730445552 | Derek G Hansen | Orthopaedic Surgery | 520 East 70th Street, Starr 2, New York, NY 10021-9800 | 2012-04-05 |
| Street Address |
2500 N STATE ST DEPARMENT OF MEDICINE |
| City | JACKSON |
| State | MS |
| Zip Code | 39216 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1477556231 | University Ophthalmology Associates | Ophthalmology | 2500 N State St, Ste B329, Jackson, MS 39216-4500 | 2005-05-24 |
| 1396346607 | Ashleigh Renfroe Hannah | Nurse Practitioner | 2500 N State St, Jackson, MS 39216-4500 | 2020-11-03 |
| 1770182438 | Tara P. Carter | Nurse Practitioner | 2500 N State St, Jackson, MS 39216-4500 | 2020-10-22 |
| 1679189849 | Raegan Wilson | Registered Nurse | 2500 N State St, Jackson, MS 39216-4500 | 2020-09-22 |
| 1851905095 | Violet Maloba Awori | Student in an Organized Health Care Education/Training Program | 2500 N State St, Jackson, MS 39216-4500 | 2020-09-04 |
| 1295348639 | Kassidy Voinche | Pharmacist | 2500 N State St, Jackson, MS 39216-4500 | 2020-08-25 |
| 1215549423 | Brittney Leeann Williams | Pharmacist | 2500 N State St, Jackson, MS 39216-4500 | 2020-08-19 |
| 1912519364 | Rashmi Verma | Internal Medicine | 2500 N State St, Jackson, MS 39216-4500 | 2020-08-18 |
| 1982215414 | Anita Dhanrajani | Pediatrics | 2500 N State St, Jackson, MS 39216-4500 | 2020-08-10 |
| 1528676954 | Nicholas Mcafee | Psychologist | 2500 N State St, Jackson, MS 39216-4500 | 2020-07-22 |
| Find all providers in the same location | ||||
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1861011553 | Ashley Melancon Prewitt | Registered Nurse | St. Dominic's North Campus, Behavioral Health, Jackson, MS 39216 | 2020-04-13 |
| 1194353391 | Brianna Arrington | Student in an Organized Health Care Education/Training Program | Med/ Peds, 2500 N. State St., Jackson, MS 39216 | 2020-04-01 |
| 1720616485 | Roshina Khalid Khan | Student in an Organized Health Care Education/Training Program | Department of Anesthesiology, Ummc, 2500 N. State St., Jackson, MS 39216 | 2020-03-30 |
| 1275183550 | Amanda Lynn Morellato | Dentist | Ummc School of Dentistry, 2500 North State Street, Jackson, MS 39216 | 2019-09-18 |
| 1396305553 | Abhishek Chhabra | Student in an Organized Health Care Education/Training Program | Lakeland Family Medicine Clinic, 878 Lakeland Dr., Jackson, MS 39216 | 2019-06-19 |
| 1427615996 | Hometown Diagnostics | Clinical Medical Laboratory | Translational Research Center Tr311, 2500 North State Street, Jackson, MS 39216 | 2019-05-21 |
| 1346807773 | Shukundala C Smith | Behavior Technician | New Learning Resources 2510 Lakeland Terrace, Jackson, MS 39216 | 2019-05-21 |
| 1063901098 | G Eli Howell Md Pllc | Plastic Surgery | 971 Lakeland Dr Ste 225, Jackson, MS 39216 | 2018-05-04 |
| 1588168132 | Caleb Zumbro | Student in an Organized Health Care Education/Training Program | Ummc Med/peds, 2500 N. State St., Jackson, MS 39216 | 2018-03-20 |
| 1639677230 | Walgreen Co | Pharmacy | 971 Lakeland Dr Ste 101, Jackson, MS 39216 | 2018-01-29 |
| Find all providers in zip 39216 | ||||
| Taxonomy Code | 207RC0200X |
| Grouping | Allopathic & Osteopathic Physicians |
| Classification | Internal Medicine |
| Specialization | Critical Care Medicine |
| An internist who diagnoses, treats and supports patients with multiple organ dysfunction. This specialist may have administrative responsibilities for intensive care units and may also facilitate and coordinate patient care among the primary physician, the critical care staff and other specialists. |
| Notes: Source: American Board of Medical Specialties, 2007. www.abms.org [7/1/2007: added definition, added source; 7/1/2011: modified source] - Additional Resources: American Board of Internal Medicine, 2007. http://www.abim.org/. American Osteopathic Board of Internal Medicine, 2007. http://www.osteopathic.org/certification - Board certification for Medical Doctors (MDs) is provided by the American Board of Internal Medicine. Board certification for Doctors of Osteopathy (DOs) is provided by the American Osteopathic Board of Internal Medicine. |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1437312915 | Raymond L. Portis | Internal Medicine | 1200 N State St, Suite 480, Jackson, MS 39202-2000 | 2008-07-06 |
| 1841453354 | Pulmonary Associates of Mobile, PC | Internal Medicine | 220 Hospital Dr, Jackson, AL 36545-2459 | 2008-07-03 |
| 1235144114 | Geeta G Gyamlani | Internal Medicine | 1500 E Woodrow Wilson Ave, Jackson, MS 39216-5116 | 2006-07-29 |
| 1215967500 | Jay G Shake | Internal Medicine | 2500 N State St, Jackson, MS 39216-4500 | 2006-07-03 |
| 1811976582 | Nauman A Chaudary | Internal Medicine | 2500 North State Street, Department of Medicine Division of Pulmonary, Jackson, MS 39216-4500 | 2006-01-11 |
| 1629063227 | Robert Gilroy | Internal Medicine | 700 W Forest Ave, Ste 300, Jackson, TN 38301-3937 | 2005-09-20 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1730507096 | William Russell Cullinane Jr. | Internal Medicine | 15190 Community Rd Ste 110, Gulfport, MS 39503-3484 | 2014-04-03 |
| 1841570645 | Delta Critical Care & Lung Consultants P.C. | Internal Medicine | 537 Anne Stokes Rd, Greenville, MS 38701-6904 | 2011-08-24 |
| 1710049200 | Gulfshore Medical Consultants, Pa | Internal Medicine | 22a Doctors Dr, Ocean Springs, MS 39564-5721 | 2006-12-14 |
| 1093819799 | Joyce Deanette Wade-hamme | Internal Medicine | 2506 Lakeland Dr Ste 300, Flowood, MS 39232-7640 | 2006-09-12 |
| 1336243047 | William D Frazier | Internal Medicine | 161 River Oaks Dr Ste Rt1188, Canton, MS 39046-5375 | 2006-09-12 |
| 1952338659 | David M Halinski | Internal Medicine | 114 Monument Pl, Suite B, Vicksburg, MS 39180-5169 | 2006-06-27 |
| 1902861156 | Tinofa O Muskwe | Internal Medicine | 951 Howard Ave, Biloxi, MS 39530-3762 | 2006-04-19 |
| 1578569935 | Sanjay Ratnakant | Internal Medicine | 401 Southcrest Cir, Ste 212, Southaven, MS 38671-6721 | 2005-06-21 |
| 1275993792 | Hattiesburg Clinic, Pa | Internal Medicine | 415 S 28th Ave, Hattiesburg, MS 39401-7246 | 2016-02-25 |
| 1023435609 | Praneet Sivaramakrishnan Iyer | Internal Medicine | 401 Southcrest Cir Ste 212, Southaven, MS 38671-6721 | 2014-03-21 |
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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.