DR. RICHARD DERBY (NPI# 1295720845) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1295720845 |
| Entity Type | Individual |
| Full Name | DR. RICHARD DERBY |
| Credential | MD |
| Practice Address |
1512 N Green Mount Rd Suite 300 O Fallon IL 62269-2083 |
| Practice Telephone | 6186415800 |
| Practice Fax Number | 6186415825 |
| Mailing Telephone | 6186415800 |
| Mailing Fax Number | 6186415825 |
| Enumeration Date | 2005-09-20 |
| Last Update Date | 2016-07-05 |
| Gender Code | M |
| Is Sole Proprietor | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 207QS0010X |
Family Medicine Specialization: Sports Medicine |
036126121 | IL | Allopathic & Osteopathic Physicians |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1013008481 | Richard Derby Jr. | Anesthesiology | 901 Campus Drive, Suite 312, Daly City, CA 94015 | 2006-09-28 |
| 1871695882 | Richard S Derby | Counselor | 20 Glenlake Parkway, Department of Behavioral Health, Atlanta, GA 30328 | 2006-09-01 |
| Street Address |
1512 N GREEN MOUNT RD SUITE 300 |
| City | O FALLON |
| State | IL |
| Zip Code | 62269-2083 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1891787040 | Dorrie C Tredway | Family Medicine | 1512 N Green Mount Rd, Suite 108, O Fallon, IL 62269-2083 | 2005-08-15 |
| 1487142022 | Vituity - Illinois Auc LLP | Emergency Medicine | 1512 N Green Mount Rd, O Fallon, IL 62269 | 2018-04-30 |
| 1295239747 | Chandler Sparks | Student in an Organized Health Care Education/Training Program | 1512 N Green Mount Rd, O Fallon, IL 62269-2083 | 2018-03-20 |
| 1649660200 | Tara Topper | Nurse Practitioner | 1512 N Green Mount Rd, O Fallon, IL 62269-1953 | 2015-02-03 |
| 1851715692 | Infinity-meds LLP | Emergency Medicine | 1512 N Green Mount Rd, O Fallon, IL 62269-1953 | 2014-02-14 |
| 1639319387 | David Edward Bereda | Family Medicine | 1512 N Green Mount Rd, O Fallon, IL 62269-2083 | 2009-02-20 |
| 1790945103 | Ob Gyn Care LLC | Surgery | 1512 N Green Mount Rd, Suite 107, O Fallon, IL 62269-1953 | 2008-06-10 |
| 1053587402 | Amy Marie Buck | Nurse Practitioner | 1512 N Green Mount Rd, Suite 200, O Fallon, IL 62269-1953 | 2008-05-06 |
| 1932377249 | Stephen Jubinski Jr. | Family Medicine | 1512 N Green Mount Rd, Suite 108, O Fallon, IL 62269-1953 | 2008-02-20 |
| 1003091570 | St. Elizabeth Hospital | Clinic/Center | 1512 N Green Mount Rd, Suite 200, O Fallon, IL 62269-1953 | 2008-01-03 |
| Find all providers in the same location | ||||
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1326648155 | Kayla Revermann | Pharmacist | 1350 W Us Highway 50, Pharmacy, O Fallon, IL 62269 | 2020-10-30 |
| 1942814272 | Ashley Monique Gibson | Behavior Technician | Eagle Center, Ste 10, Ofallon, IL 62269 | 2020-09-03 |
| 1013533819 | Michelle Denise Voudrie | Registered Nurse | 321 Regency Park, O'fallon, IL 62269 | 2020-06-18 |
| 1598398455 | Washington University Physicians In Illinois - Cancer Center Pharmacy | Pharmacy | 1418 Cross Street, Suite 180, Shiloh, IL 62269 | 2020-02-19 |
| 1962063800 | Gerald Paskert | Pharmacist | 122 W. State St., O'fallon, IL 62269 | 2019-06-21 |
| 1780144808 | Bonnie Jean Lampe | Physical Therapy Assistant | 316 Donna Dr, O'fallon, IL 62269 | 2019-03-24 |
| 1134633993 | Latisha Smith | Psychologist | 600 S. Smiley St., O'fallon, IL 62269 | 2017-11-30 |
| 1619407210 | Brenna M Thomas | Registered Nurse | 1310 Engle Ct, O'fallon, IL 62269 | 2017-06-15 |
| 1881135622 | Pc Associates, LLC | Family Medicine | 800 East Highway 50, O'fallon, IL 62269 | 2017-03-13 |
| 1700230539 | Jennifer Farrell | Family Medicine | 3 St. Elizabeth's Blvd, Ste. 4000, O'fallon, IL 62269 | 2016-04-18 |
| Find all providers in zip 62269 | ||||
| Taxonomy Code | 207QS0010X |
| Grouping | Allopathic & Osteopathic Physicians |
| Classification | Family Medicine |
| Specialization | Sports Medicine |
| A family medicine physician that is trained to be responsible for continuous care in the field of sports medicine, not only for the enhancement of health and fitness, but also for the prevention of injury and illness. A sports medicine physician must have knowledge and experience in the promotion of wellness and the prevention of injury. Knowledge about special areas of medicine such as exercise physiology, biomechanics, nutrition, psychology, physical rehabilitation, epidemiology, physical evaluation, injuries (treatment and prevention and referral practice) and the role of exercise in promoting a healthy lifestyle are essential to the practice of sports medicine. The sports medicine physician requires special education to provide the knowledge to improve the health care of the individual engaged in physical exercise (sports) whether as an individual or in team participation. |
| 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 Family Medicine, 2007. http://www.theabfm.org/. American Osteopathic Board of Family Medicine, 2007. http://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 Medicine. |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1376575126 | Ahmed A. Radwan | Family Medicine | 1512 N Green Mount Rd, Suite 200, O Fallon, IL 62269-1953 | 2006-07-06 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1164817334 | Shachi Pandya | Family Medicine | 18350 Kedzie Ave Ste 101, Homewood, IL 60430 | 2015-04-03 |
| 1821438185 | Marianne Hana | Family Medicine | 60 Orland Square Dr Ste 101, Orland Park, IL 60462 | 2013-07-01 |
| 1376894501 | Rush-copley Medical Group | Family Medicine | 2040 Ogden Ave., Suite 304, Aurora, IL 60504 | 2012-09-27 |
| 1144495961 | Karsten B Slater | Family Medicine | 1527 College Dr, Mount Carmel, IL 62863 | 2008-04-23 |
| 1104000561 | Competitive Edge Sports Medicine | Family Medicine | 14160 Jamestown Rd, Breese, IL 62230 | 2007-12-20 |
| 1477734150 | Sashil Singh Kapur | Family Medicine | 415 N Lasalle Street, Suite 100, Chicago, IL 60654 | 2007-11-21 |
| 1659562585 | Ketan R Mody | Family Medicine | 760 Pasquinelli Dr Ste 304, Westmont, IL 60559-1290 | 2007-08-06 |
| 1285841544 | Arthur Aragones | Family Medicine | 135 E Irving Park Rd, Streamwood, IL 60107-2950 | 2007-05-17 |
| 1003028150 | Jill Wirth-rissman | Family Medicine | 205 N Cummings Ln, Washington, IL 61571-2181 | 2007-05-03 |
| 1497838676 | Christopher Eric Cieurzo | Family Medicine | 510 Pow Mia St Bldg P40, Scott Afb, IL 62225-5020 | 2006-10-23 |
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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.