Recently Updated NPI Information — some details in this NPI profile have been updated in the NPI registry within the last 60 days.

ANNIE DERTHICK PHD
NPI 1689039422
Psychologist - Clinical in Kennesaw, GA

Q: 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.

Q: What is Annie Derthick's specialty?

The primary specialty registered for this NPI is Psychologist, specializing in Clinical, with taxonomy code 103TC0700X.

Q: 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 10 days 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 December 21, 2015PECOS Enrolled

83.95/100

CMS Quality Rating

4255 WADE GREEN RD NW STE 414, KENNESAW, GA 30144(678) 213-2194 Get Directions Write a Review

NPPES record last updated: August 18, 2026. Verified against the NPPES registry weekly; last sync: August 23, 2026.

Record update history: Aug 18, 2026, Aug 11, 2026, Aug 7, 2026 and 3 more (6 updates tracked since 2015).

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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 and maintains 2 additional practice locations.

NPPES Registry Identity

NPI1689039422

Entity TypeIndividualFemale

Primary Taxonomy103TC0700X

Provider Legal NameANNIE DERTHICKCredential: PHD

Location Address4255 WADE GREEN RD NW STE 414Kennesaw, GA 30144-1763

Mailing Address4800 N Scottsdale Rd Ste 2500Scottsdale, AZ 85251-7630

Phone(678) 213-2194

Sole ProprietorNo

Enumeration DateDecember 21, 2015

Last NPPES UpdateAugust 18, 20266 updates tracked since enumeration

NPPES CertifiedAugust 18, 2026

✔ NPI 1689039422 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses 3

★ Primary SpecialtyPsychologist · ClinicalBehavioral Health & Social Service Providers

Taxonomy Code103TC0700X

License✔ Licensed in GA · PSY900357

Definition

A psychologist who provides continuing and comprehensive mental and behavioral health care for individuals and families; consultation to agencies and communities; training, education and supervision; and research-based practice. It is a specialty in breadth -- one that is broadly inclusive of severe psychopathology -- and marked by comprehensiveness and integration of knowledge and skill from a broad array of disciplines within and outside of psychology proper. The scope of clinical psychology encompasses all ages, multiple diversities and varied systems.

Also ListedPsychologistTaxonomy 103T00000X · License 107779 (AK)

Also ListedPsychologist · FamilyTaxonomy 103TF0000X · License PS1563 (ME)

4255 WADE GREEN RD NW STE 414, Kennesaw, GA 30144

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Secondary Practice Locations 2

Location 11201 E 36th AveAnchorage, AK 99508-4372 · Phone (907) 562-9229 · Fax (907) 561-4806

Location 276 High StLewiston, ME 04240 · Phone (207) 795-2800

Medicare Participation & PECOS CMS

Medicare enrollment, assignment, and ordering and referring status from the CMS PECOS system.

Medicare Enrollment Status

✔

Enrolled in Medicare (PECOS)

Annie Derthick Phd 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.

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.

New Patient

$172.43 typical visit price

range $56.84 – $172.43

Typical copayment $43.10 (range $14.21 – $43.10)

Most-billed visit code 99205

Established Patient

$100.20 typical visit price

range $18.22 – $140.40

Typical copayment $25.05 (range $4.55 – $35.10)

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.

83.95/100

MIPS Final ScoreMerit-based Incentive Payment System · CMS Quality Payment Program

Scored as part of a group practice

Quality

60.69

Promoting Interoperability

Improvement Activities

Cost

70.81

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.

SERENA COSMO MA

Counselor (Professional)