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DR. MADORI RENAE DERICKSON DO
NPI 1447190509
Student in an Organized Health Care Education/Training Program in Jefferson, LA

Active since March 30, 2026PECOS Enrolled
1401 A JEFFERSON HIGHWAY, ACADEMIC CENTER, 1ST FLOOR, JEFFERSON, LA 70121(504) 842-3260(504) 842-3193 Get Directions Write a Review

NPPES record last updated: March 30, 2026. Verified against the NPPES registry weekly; last sync: August 30, 2026.

About Dr. Madori Renae Derickson Do NPPES

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

DR. MADORI RENAE DERICKSON DO (NPI 1447190509) is an individual student in an organized health care education/training program in Jefferson, Louisiana and active in the NPI registry since March 2026. She is enrolled in Medicare PECOS.

NPPES Registry Identity

NPI1447190509
Entity TypeIndividualFemale
Primary Taxonomy390200000X
Provider Legal NameDR. MADORI RENAE DERICKSONCredential: DO
Location Address1401 A JEFFERSON HIGHWAY, ACADEMIC CENTER, 1ST FLOORJefferson, LA 70121
Mailing Address934 Wagon Train DrHenderson, NV 89002-9532 · (636) 290-8681
Phone(504) 842-3260
Fax(504) 842-3193
Sole ProprietorNo
Enumeration DateMarch 30, 2026
NPPES CertifiedMarch 24, 2026
✔ NPI 1447190509 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses

★ Primary SpecialtyStudent in an Organized Health Care Education/Training ProgramStudent, Health Care
Taxonomy Code390200000X
Definition
An individual who is enrolled in an organized health care education/training program leading to a degree, certification, registration, and/or licensure to provide health care.
1401 A JEFFERSON HIGHWAY, Jefferson, LA 70121
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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 (PECOS)

Dr. Madori Renae Derickson Do is registered in the CMS Provider Enrollment, Chain and Ownership System (PECOS).

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.

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.

RAVI GIRISH CHACHAD
Student in an Organized Health Care Education/Training Program
1401 A JEFFERSON HIGHWAY, ACADEMIC CENTER, 1ST FLOOR
JEFFERSON, LA 70121
Jefferson Parish (504) 842-3260
BETZABETH DEL VALLE VILLANUEVA MEZA MD
Student in an Organized Health Care Education/Training Program
1401 A JEFFERSON HIGHWAY, ACADEMIC CENTER, 1ST FLOOR
JEFFERSON, LA 70121
Jefferson Parish (504) 842-3260
RACHEL EVELYN WELCH
Student in an Organized Health Care Education/Training Program
1401 A JEFFERSON HIGHWAY, ACADEMIC CENTER, 1ST FLOOR
JEFFERSON, LA 70121
Jefferson Parish (504) 842-3260
SOPHIA COULTER MD
Student in an Organized Health Care Education/Training Program
1401 A JEFFERSON HIGHWAY, ACADEMIC CENTER, 1ST FLOOR
JEFFERSON, LA 70121
Jefferson Parish (504) 842-3260
JOCELYN WENDY HUILING IHNAT
Student in an Organized Health Care Education/Training Program
1401 A JEFFERSON HIGHWAY, ACADEMIC CENTER, 1ST FLOOR
JEFFERSON, LA 70121
Jefferson Parish (504) 842-3260
JONATHAN THIEN-PHU TIEU DO
Internal Medicine
1401 A JEFFERSON HIGHWAY, ACADEMIC CENTER, 1ST FLOOR
JEFFERSON, LA 70121
Jefferson Parish (504) 842-3260
JOHN-JORDAN SHOCKLEY NUNNERY MD
Student in an Organized Health Care Education/Training Program
1401 A JEFFERSON HIGHWAY, ACADEMIC CENTER, 1ST FLOOR
JEFFERSON, LA 70121
Jefferson Parish (504) 842-3260
SARAH CLARK NEELY
Student in an Organized Health Care Education/Training Program
1401 A JEFFERSON HIGHWAY, ACADEMIC CENTER, 1ST FLOOR
JEFFERSON, LA 70121
Jefferson Parish (504) 842-3260

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 Madori Derickson's NPI number?

The NPI number for Madori Derickson is 1447190509. It was assigned to this individual provider in the NPPES registry on March 30, 2026.

Where is Madori Derickson located?

Madori Derickson practices at 1401 A Jefferson Highway Academic Center, 1st Floor, Jefferson, LA 70121. The listed phone number is (504) 842-3260.

What is Madori Derickson's specialty?

The primary specialty registered for this NPI is Student in an Organized Health Care Education/Training Program with taxonomy code 390200000X.

Is Madori Derickson enrolled in Medicare?

Yes. Madori Derickson is registered in the Medicare PECOS enrollment system.

When was this NPI record last updated?

The NPPES record for Madori Derickson was last updated on March 30, 2026. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 5 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.