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Derrick Edward Tobias

Internal Medicine

Allopathic & Osteopathic Physicians

200 E Chestnut St Ste 303, Louisville, KY 40202-1831

PECOS Enrollment

This provider is enrolled in PECOS as DERRICK TOBIAS.

Based on the most recent information from CMS, provider Derrick Edward Tobias is legally eligible to order and refer claims for Part B, HHA, DME and PMD services.

Part B
Medicare Part B
Enrolled
HHA
Home Health Agency
Enrolled
DME
Durable Medical Equipment
Enrolled
PMD
Power Mobility Device
Enrolled

CMS last updated its PECOS records 2 days ago.

Profile Details

Provider ID
1386617470
Provider Type
Individual
Full Name
Tobias, Derrick Edward
Credential
M.D

Gender
Male
Sole Proprietor
No
Enumeration Date
2/9/2006
Last Updated
7/21/2016

Contact Information

Practice Location

200 E Chestnut St Ste 303, Louisville, KY 40202-1831

(502) 629-5552

(502) 629-3132

Mailing Location

PO Box 766351, Chicago, IL 60677-6351

(502) 588-9490

(502) 272-5116

Provider Taxonomies

Code	Description	License
Code 207R00000X Primary	Description Internal Medicine Allopathic & Osteopathic Physicians	License 39298 Kentucky

Provider Identifiers

ID	Description	Issuer
ID 000028412O	Description Other	Issuer HUMANA - NIS Kentucky
ID 0752823	Description Other	Issuer CIGNA - NIS Kentucky
ID 200803120	Description Medicaid	Issuer Unlisted Indiana
ID 085911	Description Other	Issuer SIHO - NIS Kentucky
ID P00460518	Description Other	Issuer RR-MCR-KY - NIS Kentucky
ID 000000515641	Description Other	Issuer ANTHEM - NINPTSPEC
ID 2648495000	Description Other	Issuer PAD - NINPTSPEC
ID 50014705	Description Other	Issuer PASSPORT - NINPTSPEC
ID 64105570	Description Medicaid	Issuer Unlisted Kentucky

Derrick Edward Tobias

PECOS Enrollment

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