Derek Joseph Davenport, MD is a medicare enrolled "Pediatrics" physician in Eagle Mountain, Utah. He graduated from medical school in 2009 and has 16 years of diverse experience with area of expertise as Pediatric Medicine. He is a member of the group practice Central Utah Clinic Pc and his current practice location is
4095 E Pony Express Pkwy Ste 1, Eagle Mountain, Utah. You can reach out to his office (for appointments etc.) via phone at
(801) 429-8037.
Derek Joseph Davenport is licensed to practice in Utah (license number 11327523-1205) and he also participates in the medicare program. He
accepts medicare assignments (which means he accepts the Medicare-approved amount; you will not be billed for any more than the Medicare deductible and coinsurance) and his NPI Number is 1346484581.
Physician's Profile
| Full Name | Derek Joseph Davenport |
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| Gender | Male |
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| Speciality | Pediatric Medicine |
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| Experience | 16 Years |
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| Location | 4095 E Pony Express Pkwy Ste 1, Eagle Mountain, Utah |
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| Accepts Medicare Assignments | Yes. He accepts the Medicare-approved amount; you will not be billed for any more than the Medicare deductible and coinsurance. |
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Medical Education and Training:
- Derek Joseph Davenport graduated from medical school in 2009
NPI Data:
- NPI Number: 1346484581
- Provider Enumeration Date: 04/30/2009
- Last Update Date: 11/27/2023
Medicare PECOS Information:
- PECOS PAC ID: 7911140058
- Enrollment ID: I20191205001032
Medical Identifiers
Medical identifiers for Derek Joseph Davenport such as npi, medicare ID, medicare PIN, medicaid, etc.
| Identifier | Type | State | Issuer |
|---|
| 1346484581 | NPI | - | NPPES |
| 1346484581 | Other | | NPI |
| 500659989 | Medicaid | OR | |
Medical Taxonomies and Licenses
| Taxonomy | Type | License (State) | Status |
|---|
| 207R00000X | Internal Medicine | 11327523-1205 (Utah) | Secondary |
| 207R00000X | Internal Medicine | MD162235 (Oregon) | Secondary |
| 208000000X | Pediatrics | MD162235 (Oregon) | Secondary |
| 208000000X | Pediatrics | 11327523-1205 (Utah) | Primary |
Group Practice Association
| Group Practice Name | Group PECOS PAC ID | No. of Members |
|---|
| Central Utah Clinic Pc | 7517868508 | 386 |
Medicare Reassignments
Some practitioners may not bill the customers directly but medicare billing happens through clinics / group practice / hospitals where the provider works. Medicare reassignment of benefits is a mechanism by which practitioners allow third parties to bill and receive payment for medicare services performed by them. Derek Joseph Davenport allows following entities to bill medicare on his behalf.
| Entity Name | Central Utah Clinic Pc |
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| Entity Type | Part B Supplier - Clinic/group Practice |
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| Entity Identifiers | NPI Number: 1093764805
PECOS PAC ID: 7517868508
Enrollment ID: O20040113000805 |
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Medicare Part D Prescriber Enrollment
Any physician or other eligible professional who prescribes Part D drugs must either enroll in the Medicare program or opt out in order to prescribe drugs to their patients with Part D prescription drug benefit plans. Derek Joseph Davenport is
enrolled with medicare and thus, if eligible, can prescribe medicare part D drugs to patients with medicare part D benefits.
Mailing Address and Practice Location
| Mailing Address | Practice Location Address |
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Derek Joseph Davenport, MD
1055 N 500 W, Attn. Credentialing,
Provo, UT 84604
Ph: (801) 354-8225 | Derek Joseph Davenport, MD
4095 E Pony Express Pkwy Ste 1,
Eagle Mountain, UT 84005-5531
Ph: (801) 429-8037 |
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