Keith J Derickson, MD in Fort Wayne, IN - Medicare Family Practice

Keith J Derickson, MD is a medicare enrolled "Family Medicine" physician in Fort Wayne, Indiana. He went to Indiana University School Of Medicine and graduated in 2010 and has 14 years of diverse experience with area of expertise as Family Practice. He is a member of the group practice Fort Wayne Medical Education Program, Lutheran Medical Group Llc and his current practice location is 6404 Rothman Rd, Fort Wayne, Indiana. You can reach out to his office (for appointments etc.) via phone at (260) 486-6197.

Keith J Derickson is licensed to practice in Indiana (license number 01070470A) 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 1538480439.

Contact Information

	Keith J Derickson, MD
	6404 Rothman Rd, Fort Wayne, IN 46835-1366
	(260) 486-6197
	(260) 486-9862

Map and Direction

Physician's Profile

Full Name	Keith J Derickson
Gender	Male
Speciality	Family Practice
Experience	14 Years
Location	6404 Rothman Rd, Fort Wayne, Indiana
Accepts Medicare Assignments	Yes. He accepts the Medicare-approved amount; you will not be billed for any more than the Medicare deductible and coinsurance.

Medical Education and Training:

Keith J Derickson attended and graduated from Indiana University School Of Medicine in 2010

NPI Data:

NPI Number: 1538480439
Provider Enumeration Date: 06/15/2010
Last Update Date: 09/28/2020

Medicare PECOS Information:

PECOS PAC ID: 4880845619
Enrollment ID: I20130724000656

Medical Identifiers

Medical identifiers for Keith J Derickson such as npi, medicare ID, medicare PIN, medicaid, etc.

Identifier	Type	State	Issuer
1538480439	NPI	-	NPPES
201047100	Medicaid	IN

Medical Taxonomies and Licenses

Taxonomy	Type	License (State)	Status
207Q00000X	Family Medicine	01070470A (Indiana)	Primary

Medical Facilities Affiliation

Facility Name	Location	Facility Type
Lutheran Health Network Home Health	Fort wayne, IN	Home health agency
Dupont Hospital Llc	Fort wayne, IN	Hospital
St Joseph Hospital	Fort wayne, IN	Hospital
Lutheran Hospital Of Indiana	Fort wayne, IN	Hospital
Parkview Regional Medical Center	Fort wayne, IN	Hospital

Group Practice Association

Group Practice Name	Group PECOS PAC ID	No. of Members
Fort Wayne Medical Education Program	2860387933	16
Lutheran Medical Group Llc	4981751617	264

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. Keith J Derickson allows following entities to bill medicare on his behalf.

Entity Name	Fort Wayne Medical Education Program
Entity Type	Part B Supplier - Clinic/group Practice
Entity Identifiers	NPI Number: 1184635153 PECOS PAC ID: 2860387933 Enrollment ID: O20040218000034

Entity Name	Lutheran Medical Group Llc
Entity Type	Part B Supplier - Clinic/group Practice
Entity Identifiers	NPI Number: 1164662805 PECOS PAC ID: 4981751617 Enrollment ID: O20090414000705

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. Keith J Derickson 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
Keith J Derickson, MD 6920 Pointe Inverness Way Ste 200, Fort Wayne, IN 46804-7934 Ph: (260) 479-3516	Keith J Derickson, MD 6404 Rothman Rd, Fort Wayne, IN 46835-1366 Ph: (260) 486-6197

Reviews and Comments

Family Medicine Doctors in Fort Wayne, IN

Rebecca Mason, MD Family Medicine Medicare: Accepting Medicare Assignments Practice Location: 8233 Glencarin Blvd, Fort Wayne, IN 46804 Phone: 260-425-5470 Fax: 260-425-5475
Anthony D Dennis, M.D. Family Medicine Medicare: Medicare Enrolled Practice Location: 11635 Coldwater Rd, Fort Wayne, IN 46845 Phone: 260-637-1661 Fax: 260-637-1601
Dr. Charles R Pattan, M.D. Family Medicine Medicare: Accepting Medicare Assignments Practice Location: 11050 Parkview Circle Dr, Fort Wayne, IN 46845 Phone: 833-724-8326 Fax: 260-266-8941
Gregory L Chupp, MD Family Medicine Medicare: Medicare Enrolled Practice Location: 3909 New Vision Dr, Fort Wayne, IN 46845 Phone: 260-469-6610
Christina Mcguirk, Family Medicine Medicare: May Accept Medicare Assignments Practice Location: 2200 Randallia Dr, Fort Wayne, IN 46805 Phone: 260-373-4000
Samantha Dawn Warden, MD Family Medicine Medicare: Medicare Enrolled Practice Location: 750 Broadway Ste 350, Fort Wayne, IN 46802 Phone: 260-423-2675 Fax: 260-423-6621
Dr. Mary Ann O'brien, MD Family Medicine Medicare: Not Enrolled in Medicare Practice Location: 3909 New Vision Dr, Fort Wayne, IN 46845 Phone: 260-496-6602 Fax: 260-969-3065

Keith J Derickson, MD - Medicare Family Practice in Fort Wayne, IN