DERICK STACKPOLE
NPI 1396217485
Physician Assistant in Roanoke, VA
About Derick Stackpole NPPES
Official registry information on file with the National Plan and Provider Enumeration System.
DERICK STACKPOLE (NPI 1396217485) is an individual physician assistant in Roanoke, Virginia, licensed in Virginia (0110006532) and active in the NPI registry since December 2018. He is enrolled in Medicare PECOS, maintains a secondary practice location in Roanoke, and is a graduate of Other (2018).
NPPES Registry Identity
Specialties & Licenses
Secondary Practice Location 1
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
Derick Stackpole 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.
Medicare Billing Reassignment
Medicare enrollment records show Derick Stackpole reassigns Medicare billing to 1 organization. The organization bills Medicare for the services this provider delivers there.
Roanoke, VA 24014
- Physician assistant employed and billed by this organization, Virginia enrollment
- 193 clinicians in this Medicare group
Source: CMS Revalidation Reassignment List, October 2026 release. Reassignment records can lag staffing changes; confirm a current affiliation with the organization.
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.
Physician Visit Costs CMS claims · ZIP area
Typical Medicare office-visit costs in the 24018 ZIP code area, from fee-for-service claims. These are area statistics, not this provider’s prices; actual charges vary by service and coverage.
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.
ROANOKE, VA 24018
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 Derick Stackpole's NPI number?
The NPI number for Derick Stackpole is 1396217485. It was assigned to this individual provider in the NPPES registry on December 30, 2018.
Where is Derick Stackpole located?
Derick Stackpole practices at 4035 Electric Rd Ste A, Roanoke, VA 24018. The listed phone number is (540) 772-8670.
What is Derick Stackpole's specialty?
The primary specialty registered for this NPI is Physician Assistant with taxonomy code 363A00000X.
Is Derick Stackpole enrolled in Medicare?
Yes. Derick Stackpole 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 Derick Stackpole's services?
According to the CMS Revalidation Reassignment List (October 2026 release), Derick Stackpole is a physician assistant employed by Carilion Medical Center (Roanoke, VA), which bills Medicare and receives payment for Derick Stackpole'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 Derick Stackpole was last updated on August 29, 2019. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 7 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.
# Derick Stackpole · NPI 1396217485
Physician Assistant physician in Roanoke, Virginia. Individual provider, active in the CMS NPPES registry since December 30, 2018.
## Identity
- **NPI:** 1396217485 (Entity type: Individual)
- **Enumerated:** December 30, 2018
- **Primary specialty:** Physician Assistant · taxonomy 363A00000X
- **State license:** 0110006532 (Virginia)
- **Sole proprietor:** No
## Practice location
- **Address:** 4035 ELECTRIC RD STE A, Roanoke, VA 24018
- **Phone:** (540) 772-8670
## Medicare
- **Medicare:** Enrolled (PECOS); accepts Medicare assignment
- **Ordering & referring:** eligible for Part B labs & imaging, durable medical equipment, home health, power mobility devices
- **Employed and billed by:** Carilion Medical Center (NPI 1649423815, Roanoke, VA), under physician assistant employment · CMS Revalidation Reassignment List, October 2026 release
- **Medical school:** Other, class of 2018
## Record status
- **NPPES last updated:** August 29, 2019
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Source: [NPI Profile](https://npiprofile.com/npi/1396217485) · Data from the CMS NPPES public registry.