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Derek James Anderson

Family Medicine

Allopathic & Osteopathic Physicians

9001 Summa Ave, Baton Rouge, LA 70809-3726

PECOS Enrollment

This provider is enrolled in PECOS as DEREK ANDERSON.

Based on the most recent information from CMS, provider Derek James Anderson 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 yesterday at 8:18 PM.

Profile Details

Provider ID
1568468171
Provider Type
Individual
Full Name
Anderson, Derek James
Credential
MD

Gender
Male
Sole Proprietor
No
Enumeration Date
6/28/2005
Last Updated
4/29/2016

Contact Information

Practice Location

9001 Summa Ave, Baton Rouge, LA 70809-3726

(225) 761-5200

(225) 761-5487

Mailing Location

1514 Jefferson Hwy, Bldg 200, New Orleans, LA 70121-2429

(225) 237-1754

(225) 237-1722

Provider Taxonomies

Code	Description	License
Code 207Q00000X Primary	Description Family Medicine Allopathic & Osteopathic Physicians	License 10793R Louisiana

Provider Identifiers

ID	Description	Issuer
ID 990008020	Description Other	Issuer RAILROAD MEDICARE PIN Louisiana
ID 1996254	Description Medicaid	Issuer Unlisted Louisiana
ID 00876731	Description Medicaid	Issuer Unlisted Mississippi
ID 080179869	Description Other	Issuer RAILROAD MEDICARE PIN Louisiana
ID 270663YJGU	Description Other	Issuer MEDICARE PTAN Louisiana

Derek James Anderson

PECOS Enrollment

Profile Details

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