KRISTEN ALICE DERDERIAN CNP
NPI 1407417645
Nurse Practitioner - Primary Care in Saint Louis, MO

Q: What is Kristen Derderian's NPI number?

The NPI number for Kristen Derderian is 1407417645. It was assigned to this individual provider in the NPPES registry on June 27, 2019.

Q: What is Kristen Derderian's specialty?

The primary specialty registered for this NPI is Nurse Practitioner, specializing in Primary Care, with taxonomy code 363LP2300X.

Q: When was this NPI record last updated?

The NPPES record for Kristen Derderian was last updated on March 21, 2022. 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 June 27, 2019PECOS EnrolledAccepts Medicare Assignment

12200 WEBER HILL RD STE 100, SAINT LOUIS, MO 63127(314) 698-2500(314) 698-2323 Get Directions Write a Review

NPPES record last updated: March 21, 2022. Verified against the NPPES registry weekly; last sync: October 18, 2026.

Record update history: Aug 16, 2021, Nov 9, 2020, Sep 10, 2020 and 1 more (4 updates tracked since 2019).

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About Kristen Alice Derderian Cnp NPPES

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

KRISTEN ALICE DERDERIAN CNP (NPI 1407417645) is an individual primary care provider in Saint Louis, Missouri, licensed in Missouri (2021013574) and active in the NPI registry since June 2019. She is enrolled in Medicare PECOS, is affiliated with Brigham And Women's Hospital, and is a graduate of Other (2019).

NPPES Registry Identity

NPI1407417645

Entity TypeIndividualFemale

Primary Taxonomy363LP2300X

Provider Legal NameKRISTEN ALICE DERDERIANCredential: CNP

Location Address12200 WEBER HILL RD STE 100Saint Louis, MO 63127-1599

Mailing Address12200 Weber Hill Rd Ste 100Saint Louis, MO 63127-1599 · (314) 698-2500 · Fax (508) 823-5689

Phone(314) 698-2500

Fax(314) 698-2323

Sole ProprietorNo

Medical School CMSOtherGraduated 2019

Enumeration DateJune 27, 2019

Last NPPES UpdateMarch 21, 20224 updates tracked since enumeration

NPPES CertifiedMarch 21, 2022

✔ NPI 1407417645 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses

★ Primary SpecialtyNurse Practitioner · Primary CarePhysician Assistants & Advanced Practice Nursing Providers

Taxonomy Code363LP2300X

Licenses✔ Licensed in MO · 2021013574✔ Licensed in MA · RN2321686

12200 WEBER HILL RD STE 100, Saint Louis, MO 63127

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Accepted Insurance

The full list of accepted plans is on the Insurance tab. Issuers include Anthem Blue Cross and Blue Shield.Insurance ›

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

Kristen Alice Derderian Cnp 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 ID8022442326

PECOS Enrollment IDI20191219000953

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.

Medicare Billing Reassignments

Medicare enrollment records show Kristen Derderian reassigns Medicare billing to 4 organizations. Each organization bills Medicare for the services this provider delivers there; the nearest is listed first.

Mass General Brigham Medical Group Suburban Massachusetts Inc

1,041 mi

Family Medicine

2014 WASHINGTON STREET
Newton, MA 02462

Reassigned Medicare billing, Massachusetts enrollment
992 clinicians in this Medicare group

NPI 1538191218 (617) 243-6262

Steward Medical Group, Inc

1,045 mi

Specialist

9 GALEN ST
Watertown, MA 02472

Reassigned Medicare billing, Massachusetts enrollment
1,103 clinicians in this Medicare group

NPI 1629398219 (615) 467-4474

Mass General Brigham Community Physicians Inc.

1,045 mi

Internal Medicine

100 BRIGHAM WAY
Westwood, MA 02090

Reassigned Medicare billing, Massachusetts enrollment
18 clinicians in this Medicare group

NPI 1144707332 (857) 282-2028

Revere Medical Of Massachusetts, PC

1,049 mi

Internal Medicine

1 PEARL ST STE 2100
Brockton, MA 02301

Reassigned Medicare billing, Massachusetts enrollment
264 clinicians in this Medicare group

NPI 1336976539 (508) 897-6040

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 12

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 moderate level of decision making, if using time, 30 minutes or more 99214

This is a routine check-up for patients who have previously visited our clinic. It involves a comprehensive review of your health and any ongoing treatments. The consultation lasts between 30-39 minutes, allowing enough time to discuss any concerns.

208 services158 patients

Annual wellness visit, includes a personalized prevention plan of service (pps), subsequent visit G0439

An annual wellness visit is a yearly appointment with your primary care provider to create or update a personalized prevention plan. This plan helps prevent illness based on your current health and risk factors. It's a subsequent visit, meaning it follows an initial assessment.

89 services89 patients

Annual depression screening, 5 to 15 minutes G0444

An annual depression screening is a short, routine evaluation to check for signs of depression. It involves answering a series of questions about your feelings, thoughts, and behaviors. The process takes about 15 minutes and helps detect depression early for better management.

67 services67 patients

Established patient office or other outpatient visit with low level od decision making, if using time, 20 minutes or more 99213

This is a routine visit for patients who have already been seen by the healthcare provider. During this approximately 20-29 minute appointment, your health status will be evaluated and any necessary treatments or tests will be discussed. It's a chance to address any health concerns you may have.

59 services52 patients

Blood test, clotting time 85610

A clotting time blood test helps determine how quickly your blood forms clots, a process crucial to stop bleeding. During the test, a small blood sample is taken from your arm. The sample is then analyzed in a lab to see how long it takes for a clot to form.

45 services13 patients

Hemoglobin a1c level 83036

Hemoglobin A1c (HbA1c) is a test that measures your average blood sugar level over the past 2-3 months. It's used to monitor how well diabetes is being controlled. High levels may indicate that your diabetes treatment plan needs adjustment.

41 services31 patients

Administration of influenza virus vaccine G0008

The administration of the influenza virus vaccine, also known as the flu shot, is a simple procedure to protect against the flu. A healthcare provider injects a small dose of the vaccine into your arm. This stimulates your immune system to produce antibodies, which will help your body fight off the flu if exposed.

18 services18 patients

Annual alcohol misuse screening, 5 to 15 minutes G0442

An annual alcohol misuse screening is a 15-minute check-up to assess your drinking habits. It helps identify if you're consuming alcohol in a way that could harm your health. This is not a judgment, but a tool to promote your wellbeing.

15 services15 patients

Detection test by immunoassay with direct visual observation for streptococcus, group a (strep) 87880

A detection test by immunoassay for Group A Strep is a quick procedure to identify a bacterial infection in your throat. It involves taking a throat swab and applying it to a test strip, which changes color if Strep bacteria are present.

14 services11 patients

Pneumococcal conjugate vaccine, 20 valent (pcv20), for intramuscular use 90677

The Pneumococcal Conjugate Vaccine (PCV20) is a shot given to protect against 20 types of bacteria that can cause serious infections like pneumonia and meningitis. It's administered through a muscle, usually in the arm. It's important for overall health.

12 services12 patients

Routine electrocardiogram (ecg) using at least 12 leads with interpretation and report 93000

An electrocardiogram (ECG) is a non-invasive test that records your heart's electrical activity. Using 12 leads attached to your body, it captures data to help identify heart conditions. A doctor interprets the results and provides a report.

12 services12 patients

Administration of pneumococcal vaccine G0009

The pneumococcal vaccine helps protect against pneumococcal bacteria, which can cause severe infections like pneumonia and meningitis. The vaccine is given as an injection, typically in the arm. It's recommended for infants, older adults, and those with certain health conditions.

12 services12 patients

Hospital Affiliations CMS Care Compare 2

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

Brigham And Women's Hospital

Acute Care Hospitals · Boston, MA

5/5 CMS rating

OwnershipVoluntary non-profit - Private

CMS Certification Number220110

Location75 Francis StreetBoston, MA 02115 · Suffolk County

Emergency services Birthing friendly

Faulkner Hospital-Brigham And Women's

Acute Care Hospitals · Boston, MA

5/5 CMS rating

OwnershipVoluntary non-profit - Private

CMS Certification Number220119

Location1153 Centre StreetBoston, MA 02130 · Suffolk County

Emergency services

Physician Visit Costs CMS claims · ZIP area

Typical Medicare office-visit costs in the 63127 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

$86.32 typical visit price

range $55.65 – $169.38

Typical copayment $21.58 (range $13.91 – $42.34)

Most-billed visit code 99203

Established Patient

$98.37 typical visit price

range $17.76 – $137.92

Typical copayment $24.59 (range $4.44 – $34.48)

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 6

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

DINA HELINA FLEMING DO

Family Medicine