DR. DUSTIN CLIFTON DERRICK M.D.
NPI 1295049070
Plastic Surgery in Fort Worth, TX

Q: What is Dustin Derrick's NPI number?

The NPI number for Dustin Derrick is 1295049070. It was assigned to this individual provider in the NPPES registry on August 3, 2010.

Q: What is Dustin Derrick's specialty?

The primary specialty registered for this NPI is Plastic Surgery with taxonomy code 208200000X.

Q: When was this NPI record last updated?

The NPPES record for Dustin Derrick was last updated on October 13, 2021. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 4 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.

Active since August 03, 2010PECOS EnrolledAccepts Medicare Assignment

800 12TH AVE STE 100, FORT WORTH, TX 76104(817) 810-0770(817) 820-0242 Get Directions Write a Review

NPPES record last updated: October 13, 2021. Verified against the NPPES registry weekly; last sync: August 02, 2026.

Record update history: Oct 13, 2021, Mar 8, 2021, Nov 16, 2018 (3 updates tracked since 2018).

On this page

About Dr. Dustin Clifton Derrick M.d. NPPES

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

DR. DUSTIN CLIFTON DERRICK M.D. (NPI 1295049070) is an individual plastic surgery provider in Fort Worth, Texas, licensed in Texas (Q4085) and active in the NPI registry since August 2010. He is enrolled in Medicare PECOS, is affiliated with Texas Health Harris Methodist Hospital Fort Worth, and is a graduate of University Of Texas Medical School At San Antonio (2010).

NPPES Registry Identity

NPI1295049070

Entity TypeIndividualMale

Primary Taxonomy208200000X

Provider Legal NameDR. DUSTIN CLIFTON DERRICKCredential: M.D.

Location Address800 12TH AVE STE 100Fort Worth, TX 76104-2519

Mailing Address800 12th Ave Ste 100Fort Worth, TX 76104-2519 · (817) 810-0770 · Fax (817) 820-0242

Phone(817) 810-0770

Fax(817) 820-0242

Sole ProprietorYes

Medical School CMSUniversity Of Texas Medical School At San AntonioGraduated 2010

Enumeration DateAugust 3, 2010

Last NPPES UpdateOctober 13, 20213 updates tracked since enumeration

NPPES CertifiedOctober 13, 2021

✔ NPI 1295049070 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses 3

★ Primary SpecialtyPlastic SurgeryAllopathic & Osteopathic Physicians

Taxonomy Code208200000X

License✔ Licensed in TX · Q4085

Definition

A plastic surgeon deals with the repair, reconstruction or replacement of physical defects of form or function involving the skin, musculoskeletal system, craniomaxillofacial structures, hand, extremities, breast and trunk and external genitalia or cosmetic enhancement of these areas of the body. Cosmetic surgery is an essential component of plastic surgery. The plastic surgeon uses cosmetic surgical principles to both improve overall appearance and to optimize the outcome of reconstructive procedures. The surgeon uses aesthetic surgical principles not only to improve undesirable qualities of normal structures but in all reconstructive procedures as well.

Also ListedSurgeryTaxonomy 208600000X · License Q4085 (TX)

Also ListedStudent in an Organized Health Care Education/Training ProgramTaxonomy 390200000X · License 57. 025880 (OH)

800 12TH AVE STE 100, Fort Worth, TX 76104

Open in Google Maps ↗

Accepted Insurance

The full list of accepted plans is on the Insurance tab. Issuers include Blue Cross and Blue Shield of Texas, UnitedHealthcare.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

Dr. Dustin Clifton Derrick M.d. 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 ID5698089704

PECOS Enrollment IDI20180906001067

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.

Areas of Expertise CMS Part B claims 2

Services this provider delivered to Medicare fee-for-service patients, from the CMS Medicare utilization data. Higher counts generally reflect more experience with a service; care delivered outside Medicare is not included.

Established patient office or other outpatient visit with straightforward medical decision making, if using time, 10 minutes or more 99212

This is a routine check-up for patients who have previously seen the doctor. During this 10-19 minute visit, the doctor will review your health status, discuss any concerns, and manage ongoing treatments or medications. It's a chance to ensure your health is on track.

37 services19 patients

New patient office or other outpatient visit with low level of medical decision making, if using time, 30 minutes or more 99203

This service involves an initial office or outpatient visit for a new patient. The healthcare professional will spend 30-44 minutes understanding your health history, current issues, and discussing possible treatment plans. It's a comprehensive evaluation to start your healthcare journey.

21 services21 patients

Hospital Affiliations CMS Care Compare

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

Texas Health Harris Methodist Hospital Fort Worth

Acute Care Hospitals · Fort Worth, TX

3/5 CMS rating

OwnershipVoluntary non-profit - Church

CMS Certification Number450135

Location1301 Pennsylvania AvenueFort Worth, TX 76104 · Tarrant County

Emergency services Birthing friendly

Physician Visit Costs CMS claims · ZIP area

Typical Medicare office-visit costs in the 76104 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

$87.20 typical visit price

range $56.47 – $171.07

Typical copayment $21.80 (range $14.11 – $42.76)

Most-billed visit code 99203

Established Patient

$70.45 typical visit price

range $18.18 – $139.68

Typical copayment $17.61 (range $4.54 – $34.92)

Most-billed visit code 99213

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 5

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

ROBERT G ANDERSON MD

Surgery (Plastic and Reconstructive Surgery)