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DR. THERESA M DERICKSON MD
NPI 1639260169
Pediatrics in West Chester, OH

Active since September 28, 2006PECOS Enrolled
8040 PRINCETON-GLENDALE RD., WEST CHESTER, OH 45069(513) 872-2000(513) 281-8842 Get Directions Write a Review

NPPES record last updated: October 2, 2014. Verified against the NPPES registry weekly; last sync: October 25, 2026.

About Dr. Theresa M Derickson Md NPPES

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

DR. THERESA M DERICKSON MD (NPI 1639260169) is an individual pediatrics provider in West Chester, Ohio, licensed in Ohio (35088598) and active in the NPI registry since September 2006. She is enrolled in Medicare PECOS.

NPPES Registry Identity

NPI1639260169
Entity TypeIndividualFemale
Primary Taxonomy208000000X
Provider Legal NameDR. THERESA M DERICKSONCredential: MD
Location Address8040 PRINCETON-GLENDALE RD.West Chester, OH 45069-0000
Mailing Address4685 Forest Ave Ste CCincinnati, OH 45212-3359 · (513) 246-7796 · Fax (513) 852-8525
Phone(513) 872-2000
Fax(513) 281-8842
Sole ProprietorNo
Enumeration DateSeptember 28, 2006
Last NPPES UpdateOctober 2, 2014
✔ NPI 1639260169 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses

★ Primary SpecialtyPediatricsAllopathic & Osteopathic Physicians
Taxonomy Code208000000X
License✔ Licensed in OH · 35088598
Definition
A pediatrician is concerned with the physical, emotional and social health of children from birth to young adulthood. Care encompasses a broad spectrum of health services ranging from preventive healthcare to the diagnosis and treatment of acute and chronic diseases. A pediatrician deals with biological, social and environmental influences on the developing child, and with the impact of disease and dysfunction on development.
8040 PRINCETON-GLENDALE RD., West Chester, OH 45069
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Other Identifiers 1

Medicaid2704836OH

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, billing reassignment, and ordering and referring status from CMS.

Medicare Enrollment Status

✔

Enrolled in Medicare (PECOS)

Dr. Theresa M Derickson Md 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.

Medicare Billing Reassignment

Medicare enrollment records show Theresa Derickson reassigns Medicare billing to 1 organization. The organization bills Medicare for the services this provider delivers there.

Trihealth G LLC
15 mi
Internal Medicine
379 DIXMYTH AVE
Cincinnati, OH 45220
  • Reassigned Medicare billing, Ohio enrollment
  • 1,126 clinicians in this Medicare group
NPI 1295862944 (513) 246-7000

Source: CMS Revalidation Reassignment List, October 2026 release. Reassignment records can lag staffing changes; confirm a current affiliation with the organization.

Physician Visit Costs CMS claims · ZIP area

Typical Medicare office-visit costs in the 45069 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
$84.72 typical visit price
range $54.34 – $166.65
Typical copayment $21.18 (range $13.58 – $41.66)
Most-billed visit code 99203
Established Patient
$96.44 typical visit price
range $17.10 – $135.40
Typical copayment $24.11 (range $4.27 – $33.85)
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.

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 Theresa Derickson's NPI number?

The NPI number for Theresa Derickson is 1639260169. It was assigned to this individual provider in the NPPES registry on September 28, 2006.

Where is Theresa Derickson located?

Theresa Derickson practices at 8040 Princeton-Glendale Rd., West Chester, OH 45069. The listed phone number is (513) 872-2000.

What is Theresa Derickson's specialty?

The primary specialty registered for this NPI is Pediatrics with taxonomy code 208000000X.

Is Theresa Derickson enrolled in Medicare?

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

Which organization bills Medicare for Theresa Derickson's services?

According to the CMS Revalidation Reassignment List (October 2026 release), Theresa Derickson reassigns Medicare benefits to Trihealth G LLC (Cincinnati, OH). The reassignment is filed with Medicare on form CMS-855R, signed by both the clinician and the organization, and lets the organization bill Medicare and receive payment for Theresa Derickson's services. Reassignment records can lag staffing changes; confirm current arrangements with the organization.

What insurance does Theresa Derickson accept?

Health plans from Ambetter Health, Ambetter from Buckeye Health Plan, Ambetter from Meridian, Anthem Blue Cross and Blue Shield and CareSource and 2 other insurers list Theresa 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.

When was this NPI record last updated?

The NPPES record for Theresa Derickson was last updated on October 2, 2014. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 12 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.