ANNIE DERTHICK PHD
NPI 1689039422
Psychologist - Clinical in Kennesaw, GA
About Annie Derthick Phd NPPES
Official registry information on file with the National Plan and Provider Enumeration System.
ANNIE DERTHICK PHD (NPI 1689039422) is an individual clinical provider in Kennesaw, Georgia, licensed in Georgia (PSY900357) and active in the NPI registry since December 2015. She is enrolled in Medicare PECOS, maintains 2 additional practice locations, and is a graduate of Other (2015).
NPPES Registry Identity
Specialties & Licenses 3
Secondary Practice Locations 2
Accepted 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
Annie Derthick Phd 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 Reassignments
2Medicare enrollment records show Annie Derthick reassigns Medicare billing to 2 organizations. Each organization bills Medicare for the services this provider delivers there; the nearest is listed first.
Stockbridge, GA 30281
- Reassigned Medicare billing, Georgia enrollment
- 592 clinicians in this Medicare group
Lewiston, ME 04240
- Reassigned Medicare billing, Maine enrollment
- 920 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.
Physician Visit Costs CMS claims · ZIP area
Typical Medicare office-visit costs in the 30144 ZIP code area, from fee-for-service claims. These are area statistics, not this provider’s prices; actual charges vary by service and coverage.
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.
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.
KENNESAW, GA 30144
KENNESAW, GA 30144
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 Annie Derthick's NPI number?
The NPI number for Annie Derthick is 1689039422. It was assigned to this individual provider in the NPPES registry on December 21, 2015.
Where is Annie Derthick located?
Annie Derthick practices at 4255 Wade Green Rd NW Ste 414, Kennesaw, GA 30144. The listed phone number is (678) 213-2194.
What is Annie Derthick's specialty?
The primary specialty registered for this NPI is Psychologist, specializing in Clinical, with taxonomy code 103TC0700X.
Is Annie Derthick enrolled in Medicare?
Yes. Annie Derthick 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 organizations bill Medicare for Annie Derthick's services?
According to the CMS Revalidation Reassignment List (October 2026 release), Annie Derthick reassigns Medicare benefits to 2 organizations: Personal Recovery Network LLC (Stockbridge, GA) and Central Maine Medical Center (Lewiston, ME). Each 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 Annie Derthick's services. Reassignment records can lag staffing changes; confirm current arrangements with the organization.
What insurance does Annie Derthick accept?
Health plans from Anthem Blue Cross and Blue Shield list Annie Derthick 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 Annie Derthick was last updated on August 18, 2026. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 2 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.
# Annie Derthick, PHD · NPI 1689039422
Clinical provider in Kennesaw, Georgia. Individual provider, active in the CMS NPPES registry since December 21, 2015.
## Identity
- **NPI:** 1689039422 (Entity type: Individual)
- **Enumerated:** December 21, 2015
- **Primary specialty:** Psychologist - Clinical · taxonomy 103TC0700X
- **State license:** PSY900357 (Georgia)
- **Sole proprietor:** No
## Practice location
- **Address:** 4255 WADE GREEN RD NW STE 414, Kennesaw, GA 30144-1763
- **Phone:** (678) 213-2194
## Medicare
- **Medicare:** Enrolled (PECOS); accepts Medicare assignment
- **Ordering & referring:** eligible for Part B labs & imaging, durable medical equipment, home health, power mobility devices
- **Bills Medicare through:** 2 organizations under Medicare reassignment (form CMS-855R): Personal Recovery Network LLC (NPI 1881990869, Stockbridge, GA); Central Maine Medical Center (NPI 1689653487, Lewiston, ME) · CMS Revalidation Reassignment List, October 2026 release
- **Medical school:** Other, class of 2015
## Record status
- **NPPES last updated:** August 18, 2026
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Source: [NPI Profile](https://npiprofile.com/npi/1689039422) · Data from the CMS NPPES public registry.