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JENNA ELIZ TAN DERIVERA CAA
NPI 1255123345
Anesthesiologist Assistant in Washington, DC

Active since May 22, 2025Accepts Medicare Assignment
1200 PECAN ST SE, WASHINGTON, DC 20032(202) 823-4220 Get Directions Write a Review

NPPES record last updated: May 22, 2025. Verified against the NPPES registry weekly; last sync: July 26, 2026.

About Jenna Eliz Tan Derivera Caa NPPES

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

JENNA ELIZ TAN DERIVERA CAA (NPI 1255123345) is an individual anesthesiologist assistant in Washington, District Of Columbia and active in the NPI registry since May 2025. She is a graduate of Case Western University School Of Dental Medicine (2025).

NPPES Registry Identity

NPI1255123345
Entity TypeIndividualFemale
Primary Taxonomy367H00000X
Provider Legal NameJENNA ELIZ TAN DERIVERACredential: CAA
Location Address1200 PECAN ST SEWashington, DC 20032-2652
Mailing Address2300 M St Nw Fl 7Washington, DC 20037-1434 · (202) 823-4220 · Fax (202) 823-4221
Phone(202) 823-4220
Sole ProprietorNo
Medical School CMSCase Western University School Of Dental MedicineGraduated 2025
Enumeration DateMay 22, 2025
NPPES CertifiedMay 22, 2025
✔ NPI 1255123345 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses

★ Primary SpecialtyAnesthesiologist AssistantPhysician Assistants & Advanced Practice Nursing Providers
Taxonomy Code367H00000X
Definition
An individual certified by the state to perform anesthesia services under the direct supervision of an anesthesiologist. Anesthesiologist Assistants are required to have a bachelor's degree with a premed curriculum prior to entering a two-year anesthesiology assistant program, which is focused upon the delivery and maintenance of anesthesia care as well as advanced patient monitoring techniques. An Anesthesiologist Assistant must work as a member of the anesthesia care team under the direction of a qualified Anesthesiologist.
1200 PECAN ST SE, Washington, DC 20032
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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

Jenna Eliz Tan Derivera Caa 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 ID2163937145
PECOS Enrollment IDI20250717002228

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.

UHS EAST END SUB, LLC
Clinic/Center (End-Stage Renal Disease (ESRD) Treatment)
1200 PECAN ST SE
WASHINGTON, DC 20032
District of Columbia (771) 444-6200
ANNA R BELLETTIERE
Physician Assistant
1200 PECAN ST SE
WASHINGTON, DC 20032
District of Columbia (771) 444-6200
SARAH GANJI MD
Psychiatry & Neurology (Epilepsy)
1200 PECAN ST SE
WASHINGTON, DC 20032
District of Columbia (771) 444-6200
KATHRYN ANN HUGHES MD
Surgery
1200 PECAN ST SE
WASHINGTON, DC 20032
District of Columbia (771) 444-6200
ANNA WOODALL MD
Internal Medicine (Critical Care Medicine)
1200 PECAN ST SE
WASHINGTON, DC 20032
District of Columbia (771) 444-6200
BRENNA KELSEY LLOYD
Physician Assistant
1200 PECAN ST SE
WASHINGTON, DC 20032
District of Columbia (803) 931-6043
UHS EAST END SUB, LLC
General Acute Care Hospital
1200 PECAN ST SE
WASHINGTON, DC 20032
District of Columbia (804) 237-7129
RAZA TARIQ
Psychiatry & Neurology (Psychiatry)
1200 PECAN ST SE
WASHINGTON, DC 20032
District of Columbia (202) 741-2184

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 Jenna Eliz Derivera's NPI number?

The NPI number for Jenna Eliz Derivera is 1255123345. It was assigned to this individual provider in the NPPES registry on May 22, 2025.

Where is Jenna Eliz Derivera located?

Jenna Eliz Derivera practices at 1200 Pecan St SE, Washington, DC 20032. The listed phone number is (202) 823-4220.

What is Jenna Eliz Derivera's specialty?

The primary specialty registered for this NPI is Anesthesiologist Assistant with taxonomy code 367H00000X.

Is Jenna Eliz Derivera enrolled in Medicare?

Yes. Jenna Eliz Derivera 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.

When was this NPI record last updated?

The NPPES record for Jenna Eliz Derivera was last updated on May 22, 2025. NPI Profile syncs with the weekly NPPES data releases published by CMS.