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JETTA DERASIN NP NPI 1720336910


NPI Information

NPI: 1720336910
Provider Name: JETTA DERASIN, NP
Classification: Family Medicine - 207QA0401X
Entity Type: Individual

Specialization: Addiction Medicine

Organization: ADELANTE HEALTHCARE INC

PECOS Registration: Yes

Address:
1705 W MAIN ST
MESA, AZ
ZIP 85201
Phone: (877) 809-5092
Get Directions

Jetta Derasin, NP is an addiction medicine family medicine in Mesa, AZ with 14 years of experience. The provider is a family medicine physician who specializes in the diagnosis and treatment of addictions. Jetta Derasin, NP NPI is 1720336910. The provider is registered as an individual entity type.

The NPPES NPI record indicates the provider is a female.

The provider's business location address is:

1705 W MAIN ST
MESA, AZ
ZIP 85201
Phone: (877) 809-5092
Fax: (480) 718-9477

The NPI 1720336910 is registered in the Medicare Provider, Enrollment, Chain and Ownership System (PECOS). The provider is legally eligible to order and refer Part B (Clinical Laboratory and Imaging), Durable Medical Equipment, Part A Home Health Agency (HHA), Power Mobility Devices.

The following top HCPCS codes were publicly reported for this provider under the Medicare program for the year 2016. The reported codes are based on the top codes for each available Medicare specialty, excluding evaluation and management codes.

  • Insertion of needle into vein for collection of blood sample (HCPCS:36415)

The enumeration date for this NPI number is 8/21/2012 and was last updated on 1/29/2019.


Taxonomy Codes

The NPI record includes the healthcare provider taxonomy classification, state license number and state of licensure. The following information regarding the scope of practice of this provider is available:

No.Taxonomy CodeTaxonomy ClasificationTaxonomy SpecializationLicense NumberLicense StatePrimary
1207QA0401XFamily MedicineAddiction MedicineAP10652ARIZONAYes
2363L00000XNurse Practitioner66001WEST VIRGINIANo
3363LF0000XNurse PractitionerFamily3007628KENTUCKYNo
4363LP2300XNurse PractitionerPrimary CareAP10652ARIZONANo

Other Identifiers

The following information regarding additional identifiers associated to this NPI record includes the other identifier number, identifier type, identifier state and issuer.

No.Other Provider IdentifierOther Provider Identifier TypeOther Provider Identifier StateOther Provider Identifier Issuer
17100218950MEDICAIDKENTUCKY
23810025120MEDICAIDWEST VIRGINIA
30072341MEDICAIDOHIO
4204924MEDICAIDARIZONA

What is NPI?

NPI stands for National Provider Identifier. The NPI is a 10-digit identification number that is completely unique. The NPI number by itself does not contain any identifiable information such as a provider’s speciality or location. The NPI is assigned to individuals or organizacions for their lifespan and it is independent of key provider information type updates like a change of practices, location or speciality.

This page was last updated on: 11/14/2023

All materials and services on this site are provided on an "as is" and "as available" basis without warranty of any kind. The NPI record is maintained by the National Plan & Provider Enumeration System (NPPES) and anyone may request this information and other NPPES health care provider data from HHS under The Freedom of Information Act (FOIA), Title 5 of the United States Code, section 552. To update the NPI records please contact the NPPES.