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KEITH J. DERICKSON MD
NPI 1538480439
Family Medicine in Fort Wayne, IN

Active since June 15, 2010PECOS EnrolledAccepts Medicare Assignment
90.77/100
CMS Quality Rating
6404 ROTHMAN RD, FORT WAYNE, IN 46835(260) 486-6197(260) 486-9862 Get Directions Write a Review

NPPES record last updated: September 28, 2020. Verified against the NPPES registry weekly; last sync: August 02, 2026.

Record update history: Sep 28, 2020, Jan 18, 2017, Jan 7, 2017 (3 updates tracked since 2017).

About Keith J. Derickson Md NPPES

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

KEITH J. DERICKSON MD (NPI 1538480439) is an individual family medicine provider in Fort Wayne, Indiana, licensed in Indiana (01070470A) and active in the NPI registry since June 2010. He is enrolled in Medicare PECOS, is affiliated with Lutheran Hospital Of Indiana, and is a graduate of Indiana University School Of Medicine (2010).

NPPES Registry Identity

NPI1538480439
Entity TypeIndividualMale
Primary Taxonomy207Q00000X
Provider Legal NameKEITH J. DERICKSONCredential: MD
Location Address6404 ROTHMAN RDFort Wayne, IN 46835-1366
Mailing Address6920 Pointe Inverness Way Ste 200Fort Wayne, IN 46804-7934 · (260) 479-3516 · Fax (260) 479-3520
Phone(260) 486-6197
Fax(260) 486-9862
Sole ProprietorNo
Medical School CMSIndiana University School Of MedicineGraduated 2010
Enumeration DateJune 15, 2010
Last NPPES UpdateSeptember 28, 20203 updates tracked since enumeration
NPPES CertifiedSeptember 28, 2020
✔ NPI 1538480439 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses

★ Primary SpecialtyFamily MedicineAllopathic & Osteopathic Physicians
Taxonomy Code207Q00000X
License✔ Licensed in IN · 01070470A
Definition
Family Medicine is the medical specialty which is concerned with the total health care of the individual and the family. It is the specialty in breadth which integrates the biological, clinical, and behavioral sciences. The scope of family medicine is not limited by age, sex, organ system, or disease entity.
6404 ROTHMAN RD, Fort Wayne, IN 46835
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Other Identifiers 1

Medicaid201047100IN

Accepted Insurance

The full list of accepted plans is on the Insurance tab. Issuers include Ambetter from Buckeye Health Plan, Ambetter from Meridian, Ambetter Health and more.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

Keith J. Derickson Md 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 ID4880845619
PECOS Enrollment IDI20130724000656
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 9

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.
306 services166 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.
162 services99 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.
160 services160 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.
58 services39 patients
Subsequent hospital care with moderate levelof medical decision making, if using time, at least 35 minutes 99232
Follow-up hospital inpatient care involves daily check-ups while you're admitted in the hospital. Typically, a healthcare provider spends about 25 minutes each day reviewing your condition, adjusting treatment if needed, and answering any questions you might have.
34 services15 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.
26 services26 patients

Hospital Affiliations CMS Care Compare 4

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

Lutheran Hospital Of Indiana

Acute Care Hospitals · Fort Wayne, IN
3/5 CMS rating
OwnershipProprietary
CMS Certification Number150017
Location7950 W Jefferson BlvdFort Wayne, IN 46804 · Allen County
Emergency services Birthing friendly

Parkview Regional Medical Center

Acute Care Hospitals · Fort Wayne, IN
3/5 CMS rating
OwnershipVoluntary non-profit - Private
CMS Certification Number150021
Location11109 Parkview Plaza DriveFort Wayne, IN 46845 · Allen County
Emergency services Birthing friendly

St Joseph Health System, LLC

Acute Care Hospitals · Fort Wayne, IN
OwnershipProprietary
CMS Certification Number150047
Location702 Van Buren StreetFort Wayne, IN 46802 · Allen County
Emergency services

Dupont Hospital LLC

Acute Care Hospitals · Fort Wayne, IN
4/5 CMS rating
OwnershipProprietary
CMS Certification Number150150
Location2520 E Dupont RdFort Wayne, IN 46825 · Allen County
Emergency services Birthing friendly

Physician Visit Costs CMS claims · ZIP area

Typical Medicare office-visit costs in the 46835 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
$82.04 typical visit price
range $53.07 – $161.76
Typical copayment $20.51 (range $13.26 – $40.44)
Most-billed visit code 99203
Established Patient
$94.22 typical visit price
range $16.93 – $132.22
Typical copayment $23.55 (range $4.23 – $33.05)
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.

Medicare Quality Performance CMS QPP · MIPS

Performance in the CMS Quality Payment Program: the MIPS final score across four weighted categories, and the individual quality measures reported to Medicare.

90.77/100
MIPS Final ScoreMerit-based Incentive Payment System · CMS Quality Payment Program
Scored as part of a group practice
Quality77.07
Promoting Interoperability93
Improvement Activities40
Cost70.54

Referred Medical Equipment & Supplies CMS DME claims 10

Durable medical equipment, devices and supplies this provider ordered from DME suppliers for patients, from Medicare fee-for-service claims.

Blood glucose test or reagent strips for home blood glucose monitor, per 50 strips A4253
DME-Other DME · category DE017N
16 suppliers38 claims97 services$5.31 avg. paid by Medicare
Ostomy skin barrier, with flange (solid, flexible, or accordion), extended wear, with built-in convexity, 4 x 4 inches or smaller, each A4407
DME-Orthotic Devices · category DF010N
1 supplier11 claims100 services$7.62 avg. paid by Medicare
Ostomy pouch, drainable; for use on barrier with non-locking flange, with filter (2 piece system), each A4425
DME-Orthotic Devices · category DF010N
1 supplier11 claims140 services$3.08 avg. paid by Medicare
Full face mask used with positive airway pressure device, each A7030
DME-Other DME · category DE001N
5 suppliers14 claims14 services$80.47 avg. paid by Medicare
Face mask interface, replacement for full face mask, each A7031
DME-Other DME · category DE001N
4 suppliers11 claims33 services$32.16 avg. paid by Medicare
Filter, disposable, used with positive airway pressure device A7038
DME-Other DME · category DE001N
6 suppliers15 claims78 services$1.83 avg. paid by Medicare
Dollar amounts are the average Medicare paid the supplier per service. They are not the cost to the patient.

Other Providers at the Same Location NPPES

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

PATRICK M. HOLLY MD
Family Medicine
6404 ROTHMAN RD
FORT WAYNE, IN 46835
Allen County (260) 486-6197

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 Keith Derickson's NPI number?

The NPI number for Keith Derickson is 1538480439. It was assigned to this individual provider in the NPPES registry on June 15, 2010.

Where is Keith Derickson located?

Keith Derickson practices at 6404 Rothman Rd, Fort Wayne, IN 46835. The listed phone number is (260) 486-6197.

What is Keith Derickson's specialty?

The primary specialty registered for this NPI is Family Medicine with taxonomy code 207Q00000X.

Is Keith Derickson enrolled in Medicare?

Yes. Keith Derickson 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.

What insurance does Keith Derickson accept?

Health plans from Ambetter Health, Ambetter from Buckeye Health Plan, Ambetter from Meridian, Anthem Blue Cross and Blue Shield and CareSource list Keith Derickson as in-network in at least one marketplace plan. Coverage varies by plan and year; verify with the insurer or the provider before a visit.

Is Keith Derickson affiliated with any hospitals?

According to CMS data, Keith Derickson is affiliated with Lutheran Hospital Of Indiana, Parkview Regional Medical Center, St Joseph Health System, LLC and Dupont Hospital LLC.

When was this NPI record last updated?

The NPPES record for Keith Derickson was last updated on September 28, 2020. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 5 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.