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MR. DAVID J DEROSIER JR. ACNPC-AG, CPNP-AC
NPI 1053935072
Nurse Practitioner - Acute Care in Worcester, MA

Active since June 05, 2020PECOS EnrolledAccepts Medicare Assignment
55 LAKE AVE N, PEDIATRIC CRITICAL CARE, WORCESTER, MA 01655(774) 442-2164(774) 443-2062 Get Directions Write a Review

NPPES record last updated: December 12, 2025. Verified against the NPPES registry weekly; last sync: July 26, 2026.

Record update history: Dec 12, 2025, Oct 4, 2022, Dec 10, 2021 and 1 more (4 updates tracked since 2020).

About Mr. David J Derosier Jr. Acnpc-ag, Cpnp-ac NPPES

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

MR. DAVID J DEROSIER JR. ACNPC-AG, CPNP-AC (NPI 1053935072) is an individual acute care provider in Worcester, Massachusetts, licensed in Massachusetts (RN269379) and active in the NPI registry since June 2020. He is enrolled in Medicare PECOS, is affiliated with St Vincent Hospital, and maintains 4 additional practice locations.

NPPES Registry Identity

NPI1053935072
Entity TypeIndividualMale
Primary Taxonomy363LA2100X
Provider Legal NameMR. DAVID J DEROSIER JR.Credential: ACNPC-AG, CPNP-AC
Location Address55 LAKE AVE N, PEDIATRIC CRITICAL CAREWorcester, MA 01655-0002
Mailing AddressPo Box 415348Boston, MA 02241-5348 · (800) 225-8885 · Fax (508) 334-1977
Phone(774) 442-2164
Fax(774) 443-2062
Sole ProprietorNo
Medical School CMSOtherGraduated 2019
Enumeration DateJune 5, 2020
Last NPPES UpdateDecember 12, 20254 updates tracked since enumeration
NPPES CertifiedDecember 12, 2025
✔ NPI 1053935072 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses 3

★ Primary SpecialtyNurse Practitioner · Acute CarePhysician Assistants & Advanced Practice Nursing Providers
Taxonomy Code363LA2100X
License✔ Licensed in MA · RN269379
Also ListedNurse PractitionerTaxonomy 363L00000X · License RN269379 (MA)
Also ListedNurse Practitioner · PediatricsTaxonomy 363LP0200X · License RN269379 (MA)
55 LAKE AVE N, Worcester, MA 01655
Open in Google Maps ↗

Secondary Practice Locations 4

Location 1123 Summer StWorcester, MA 01608-1216 · Phone (508) 363-5000
Location 2119 Belmont StWorcester, MA 01605-2903 · Phone (774) 441-6468 · Fax (508) 793-6315
Location 3300 Longwood AveBoston, MA 02115-5724 · Phone (617) 355-6000
Location 455 Lake Ave NWorcester, MA 01655-0002 · Phone (774) 441-6468 · Fax (508) 793-6315

Medicare Participation & PECOS CMS

Medicare enrollment, assignment, and ordering and referring status from the CMS PECOS system.

Medicare Enrollment Status

✔

Enrolled in Medicare and accepts Medicare assignment

Mr. David J Derosier Jr. Acnpc-ag, Cpnp-ac is registered in PECOS and agrees to accept the Medicare-approved amount as full payment. Medicare patients are not billed beyond the standard deductible and coinsurance.

PECOS PAC ID9032642293
PECOS Enrollment IDI20241025002046
Eligible to Order & Refer✔ Part B Labs & Imaging✔ Durable Medical Equipment✔ Home Health Agency✔ Power Mobility DevicesPer the CMS Ordering and Referring file. Eligibility means Medicare pays claims that this provider orders or refers for these categories.

Hospital Affiliations CMS Care Compare

Hospitals where this provider delivers care, identified from recent Medicare claims and place-of-service records.

St Vincent Hospital

Acute Care Hospitals · Worcester, MA
2/5 CMS rating
OwnershipProprietary
CMS Certification Number220176
Location123 Summer StreetWorcester, MA 01608 · Worcester County
Emergency services Birthing friendly

Physician Visit Costs CMS claims · ZIP area

Typical Medicare office-visit costs in the 01655 ZIP code area, from fee-for-service claims. These are area statistics, not this provider’s prices; actual charges vary by service and coverage.

New Patient
$90.70 typical visit price
range $58.86 – $177.36
Typical copayment $22.67 (range $14.71 – $44.34)
Most-billed visit code 99203
Established Patient
$103.48 typical visit price
range $19.11 – $144.84
Typical copayment $25.87 (range $4.77 – $36.21)
Most-billed visit code 99214
Amounts reflect what Medicare beneficiaries in this ZIP area are typically charged for office visits. Patients with other coverage should check their individual plans.

Other Providers at the Same Location NPPES 20

Providers registered at the same practice address, or within the immediate area, according to the NPPES registry.

HILLARY R. IRONS MD
Emergency Medicine
55 LAKE AVE N
WORCESTER, MA 01655
Worcester County (508) 421-1400
MS. EILEEN A. DUHAMEL NP
Nurse Practitioner
55 LAKE AVE N, DEPARTMENT OF RADIOLOGY
WORCESTER, MA 01655
Worcester County (508) 334-2710
EWA HRYNISZYN CRNA
Nurse Anesthetist, Certified Registered
55 LAKE AVE N, DEPARTMENT OF ANESTHESIOLOGY
WORCESTER, MA 01655
Worcester County (508) 334-3271
HELEN COPSEY PA-C
Physician Assistant
55 LAKE AVE N
WORCESTER, MA 01655
Worcester County (508) 334-8585
DR. ADEPEJU GBADEBO CHAMPION M.D.
Internal Medicine
55 LAKE AVE N
WORCESTER, MA 01655
Worcester County (508) 334-2731
SOWMYA KORAPATI
Internal Medicine (Hematology & Oncology)
55 LAKE AVE N
WORCESTER, MA 01655
Worcester County (508) 334-3550
LAYLA FAKHRZADEH M.D.
Anesthesiology
55 LAKE AVE N, ANESTHESIOLOGY
WORCESTER, MA 01655
Worcester County (508) 334-3271
YOONYIE CHO M.D.
Anesthesiology
55 LAKE AVE N
WORCESTER, MA 01655
Worcester County (508) 334-1000

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 David Derosier's NPI number?

The NPI number for David Derosier is 1053935072. It was assigned to this individual provider in the NPPES registry on June 5, 2020.

Where is David Derosier located?

David Derosier practices at 55 Lake Ave N Pediatric Critical Care, Worcester, MA 01655. The listed phone number is (774) 442-2164.

What is David Derosier's specialty?

The primary specialty registered for this NPI is Nurse Practitioner, specializing in Acute Care, with taxonomy code 363LA2100X.

Is David Derosier enrolled in Medicare?

Yes. David Derosier is registered in the Medicare PECOS system and accepts Medicare assignment, which means accepting the Medicare-approved amount as payment in full for covered services.

Is David Derosier affiliated with any hospitals?

According to CMS data, David Derosier is affiliated with St Vincent Hospital.

When was this NPI record last updated?

The NPPES record for David Derosier was last updated on December 12, 2025. NPI Profile syncs with the weekly NPPES data releases published by CMS.