1. Home
  2. Directory
  3. District Of Columbia
  4. Washington
  5. Anesthesiologist Assistant
  6. NPI Profile

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: October 18, 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
Open in Google Maps ↗

Medicare Participation & PECOS CMS

Medicare enrollment, assignment, billing reassignment, and ordering and referring status from CMS.

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

Medicare Billing Reassignment

Medicare enrollment records show Jenna Eliz Derivera reassigns Medicare billing to 1 organization. The organization bills Medicare for the services this provider delivers there.

Medical Faculty Associates, Inc
4.6 mi
Anesthesiology
2150 PENNSYLVANIA AVE NW, SUITE 10-409A
Washington, DC 20037
  • Reassigned Medicare billing, District of Columbia enrollment
  • 1,275 clinicians in this Medicare group
NPI 1417990581 (202) 741-3350

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

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.

GREATER WASHINGTON ANESTHESIA NETWORK PLLC
Anesthesiology
1200 PECAN ST SE
WASHINGTON, DC 20032
District of Columbia (771) 444-6200
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

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.

Which organization bills Medicare for Jenna Eliz Derivera's services?

According to the CMS Revalidation Reassignment List (October 2026 release), Jenna Eliz Derivera reassigns Medicare benefits to Medical Faculty Associates, Inc (Washington, DC). The 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 Jenna Eliz Derivera's services. Reassignment records can lag staffing changes; confirm current arrangements with the organization.

When was this NPI record last updated?

The NPPES record for Jenna Eliz Derivera was last updated on May 22, 2025. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 17 months 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.