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SHEMIAH R DERRICK INC.
NPI 1003412909
Clinic/Center - Adult Mental Health in Chicago, IL

Active since December 07, 2020
6127 S UNIVERSITY AVE STE 109, CHICAGO, IL 60637(773) 424-2007 Get Directions Write a Review

NPPES record last updated: December 7, 2020. Verified against the NPPES registry weekly; last sync: October 25, 2026.

About Shemiah R Derrick Inc. NPPES

Official registry information on file with the National Plan and Provider Enumeration System.

SHEMIAH R DERRICK INC. (NPI 1003412909), doing business as Profound Peace Psychotherapy Collective, is a healthcare organization registered as an adult mental health in Chicago, Illinois and active in the NPI registry since December 2020. The organization lists Shemiah R. Derrick, President & Owner, as its authorized official.

NPPES Registry Identity

NPI1003412909
Entity TypeOrganization
Primary Taxonomy261QM0850X
Legal Business NameSHEMIAH R DERRICK INC.
Location Address6127 S UNIVERSITY AVE STE 109Chicago, IL 60637-5894
Mailing Address6127 S University Ave Ste 109Chicago, IL 60637-5894 · (773) 424-2007
Phone(773) 424-2007
Organization SubpartNo
Authorized OfficialShemiah R. DerrickPresident & Owner · (773) 424-2007
Enumeration DateDecember 7, 2020
NPPES CertifiedDecember 7, 2020
✔ NPI 1003412909 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses 2

★ Primary SpecialtyClinic/Center · Adult Mental HealthAmbulatory Health Care Facilities
Taxonomy Code261QM0850X
Definition
An entity, facility, or distinct part of a facility providing diagnostic, treatment, and prescriptive services related to mental and behavioral disorders in adults.
Also ListedClinic/Center · Mental Health (Including Community Mental Health Center)Taxonomy 261QM0801X
6127 S UNIVERSITY AVE STE 109, Chicago, IL 60637
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Other Names 1

Doing Business AsProfound Peace Psychotherapy Collective

Medicare Participation & PECOS CMS

Medicare enrollment and the clinicians who bill Medicare through this organization, from CMS.

Medicare Enrollment Status

✔

Enrolled in Medicare (PECOS)

Shemiah R Derrick Inc. is registered in the CMS Provider Enrollment, Chain and Ownership System (PECOS).

Clinicians Billing Medicare Through This Organization

Medicare enrollment records show 1 clinician reassigns Medicare billing to Shemiah R Derrick Inc., which bills Medicare for the services this clinician delivers.

Clinician (1)

Shemiah Derrick
Mental Health Counselor
NPI 1518419027
6127 S UNIVERSITY AVE STE 109
Chicago, IL 60637
(773) 424-2007
✔ PECOSSame address

Source: CMS Revalidation Reassignment List, October 2026 release. Reassignment records can lag staffing changes; confirm a current affiliation with the organization.

Frequently Asked Questions NPPES & CMS

Common questions about this NPI record, answered from the official NPPES registry and CMS datasets shown on this page.

What is Shemiah R Derrick Inc.'s NPI number?

The NPI number for Shemiah R Derrick Inc. is 1003412909. It was assigned to this organization in the NPPES registry on December 7, 2020. The provider is doing business as Profound Peace Psychotherapy Collective.

Where is Shemiah R Derrick Inc. located?

Shemiah R Derrick Inc. is located at 6127 S University Ave Ste 109, Chicago, IL 60637. The listed phone number is (773) 424-2007.

What is Shemiah R Derrick Inc.'s specialty?

The primary specialty registered for this NPI is Clinic/Center, specializing in Adult Mental Health, with taxonomy code 261QM0850X.

Is Shemiah R Derrick Inc. enrolled in Medicare?

Yes. Shemiah R Derrick Inc. is registered in the Medicare PECOS enrollment system.

How many clinicians bill Medicare through Shemiah R Derrick Inc.?

According to the CMS Revalidation Reassignment List (October 2026 release), 1 clinician (Mental Health Counselor) reassigns their Medicare billing to Shemiah R Derrick Inc.. A reassignment is filed with Medicare on form CMS-855R, signed by both the clinician and the organization, and lets the organization bill Medicare and receive payment for the clinician's services. Reassignment records can lag staffing changes; confirm a current affiliation with the organization.

When was this NPI record last updated?

The NPPES record for Shemiah R Derrick Inc. was last updated on December 7, 2020. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 5 years ago. If this record has changed at CMS more recently, you can request an on-demand re-check against the live CMS registry, directly from this page.