Recently Updated NPI Information — some details in this NPI profile have been updated in the NPI registry within the last 60 days.

SUSAN KAY DERRICKSON NP-BC
NPI 1104691153
Nurse Practitioner in Goshen, IN

Q: What is Susan Derrickson's NPI number?

The NPI number for Susan Derrickson is 1104691153. It was assigned to this individual provider in the NPPES registry on November 20, 2023.

Q: What is Susan Derrickson's specialty?

The primary specialty registered for this NPI is Nurse Practitioner with taxonomy code 363L00000X.

Q: When was this NPI record last updated?

The NPPES record for Susan Derrickson was last updated on September 9, 2026. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 17 days 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.

Active since November 20, 2023PECOS EnrolledAccepts Medicare Assignment

213 MIDDLEBURY ST, GOSHEN, IN 46528(574) 534-3300 Get Directions Write a Review

NPPES record last updated: September 9, 2026. Verified against the NPPES registry weekly; last sync: September 20, 2026.

Record update history: Sep 9, 2026, Mar 10, 2026, Nov 21, 2023 (3 updates tracked since 2023).

On this page

About Susan Kay Derrickson Np-bc NPPES

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

SUSAN KAY DERRICKSON NP-BC (NPI 1104691153) is an individual nurse practitioner in Goshen, Indiana, licensed in Indiana (71014637A) and active in the NPI registry since November 2023. She is enrolled in Medicare PECOS, maintains 6 additional practice locations, and is a graduate of Other (2021).

NPPES Registry Identity

NPI1104691153

Entity TypeIndividualFemale

Primary Taxonomy363L00000X

Provider Legal NameSUSAN KAY DERRICKSONCredential: NP-BC

Location Address213 MIDDLEBURY STGoshen, IN 46528-2956

Mailing Address710 Park Pl Fl 2Mishawaka, IN 46545-3519 · (574) 273-6767 · Fax (574) 273-6757

Phone(574) 534-3300

Sole ProprietorNo

Medical School CMSOtherGraduated 2021

Enumeration DateNovember 20, 2023

Last NPPES UpdateSeptember 9, 20263 updates tracked since enumeration

NPPES CertifiedSeptember 9, 2026

✔ NPI 1104691153 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses

★ Primary SpecialtyNurse PractitionerPhysician Assistants & Advanced Practice Nursing Providers

Taxonomy Code363L00000X

License✔ Licensed in IN · 71014637A

Definition

(1) A registered nurse provider with a graduate degree in nursing prepared for advanced practice involving independent and interdependent decision making and direct accountability for clinical judgment across the health care continuum or in a certified specialty. (2) A registered nurse who has completed additional training beyond basic nursing education and who provides primary health care services in accordance with state nurse practice laws or statutes. Tasks performed by nurse practitioners vary with practice requirements mandated by geographic, political, economic, and social factors. Nurse practitioner specialists include, but are not limited to, family nurse practitioners, gerontological nurse practitioners, pediatric nurse practitioners, obstetric-gynecologic nurse practitioners, and school nurse practitioners.

213 MIDDLEBURY ST, Goshen, IN 46528

Open in Google Maps ↗

Secondary Practice Locations 6

Location 1820 Waterbury Park DrElkhart, IN 46517-2358 · Phone (574) 273-6767 · Fax (574) 273-6757

Location 22606 Peddlers Village Rd Ste 210Goshen, IN 46526-1004 · Phone (574) 534-3300

Location 32855 Miller Dr Ste 209Plymouth, IN 46563-8096 · Phone (574) 273-6767 · Fax (574) 273-6757

Location 4808 N 3rd StGoshen, IN 46528-7100 · Phone (574) 534-0088

Location 52257 Karisa DrGoshen, IN 46526-6942 · Phone (574) 273-6767 · Fax (574) 273-6757

Location 6710 Park PlMishawaka, IN 46545-3519 · Phone (574) 273-6767 · Fax (574) 273-6757

Accepted Insurance

The full list of accepted plans is on the Insurance tab. Issuers include Ambetter from Buckeye Health Plan, Ambetter from Meridian, Ambetter Health and more.Insurance ›

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

Susan Kay Derrickson Np-bc 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 ID9739611237

PECOS Enrollment IDI20241022000191

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.

Physician Visit Costs CMS claims · ZIP area

Typical Medicare office-visit costs in the 46528 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

$82.04 typical visit price

range $53.07 – $161.76

Typical copayment $20.51 (range $13.26 – $40.44)

Most-billed visit code 99203

Established Patient

$94.22 typical visit price

range $16.93 – $132.22

Typical copayment $23.55 (range $4.23 – $33.05)

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.

MRS. KAITLYN E DELGADO FNP-BC

Nurse Practitioner (Family)