DERRICK JOHN GRUEN (PT, DPT) – Physical Therapist, NPI 1124892633

DERRICK JOHN GRUEN (PT, DPT) is a healthcare provider. based in Boulder, Colorado. specializing in PHYSICAL THERAPIST IN PRIVATE PRACTICE. They hold the professional credentials PT, DPT. They hold a License No. PT20560 (CA). The NPI Number for DERRICK JOHN GRUEN (PT, DPT) is 1124892633

Main info

Male
18 Years Of Experience
Accepts Medicare Assignment
Name
DERRICK JOHN GRUEN (PT, DPT)
NPI
1124892633
Phone
(877) 546-9158
Address
PO BOX 21150
Enumeration Date
14 November 2023
Last Update Date
14 November 2023

Doctor Profile

Medical School Name
OTHER
Secondary Phone
5595821027
Graduation Year
2008 (18 years ago)
PAC ID
6709234941
Group Practice PAC ID
4183520901
Professional Enrollment ID
I20231128002082
Address ID
CA932304511HA331XXAVEX400
Data current as of
19 May 2026

Profile Insights

NPPES metrics only — not quality of care.

Methodology
Experience28
Completeness75
Years active:2State licenses:1Digital endpointsOther names

9,449 PHYSICAL THERAPIST IN PRIVATE PRACTICE in CA

Provider Addresses for DERRICK JOHN GRUEN (PT, DPT)

  • PO BOX 21150

    BOULDER, CO 803084150

    Phone: (877) 546-9158

    Fax: (877) 546-9107

    Type: Mailing

  • 331 N 11TH AVE

    HANFORD, CA 932304511

    Phone: (559) 582-1027

    Fax: (559) 582-8105

    Type: Location

  • 5533 W Hillsdale Ave Ste A

    Visalia, CA 932915367

    Phone: (559) 733-2478

    Fax: (559) 733-2470

    Type: Location

NPPES updates history

No NPPES updates recorded for this provider.

Prescription Activity

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Open Payments (CMS)

No Open Payments data available for this provider.

This can happen when there are no reportable CMS Open Payments records.

Medicare Enrollment & Revalidation

Source: CMS public data · Not endorsed by CMS ·

Educational use only—not medical, billing, or legal advice.

PECOS enrollment status

Participating (accepts Medicare assignment)

Enrollment effective: 2023-11-28

PECOS data refreshed: 2026-05-27

Medicare revalidation (CMS due date list)

Due date not assigned yet

CMS is tracking this Medicare enrollment for revalidation, but has not published a due date.

Enrollment records

1

Earliest due date

Not assigned (TBD)

CMS data updated

2026-06-01

Revalidation progress

  1. Medicare enrolled
  2. On CMS revalidation list
  3. Due date assigned
  4. Revalidate in PECOS

CMS enrollment records

Enrollment IDTypeSpecialtyStateDue date
I20231128002082IPhysical Therapist In Private PracticeCATBD

What to do next

  • No action required while the due date shows TBD.
  • Check the CMS Revalidation Lookup Tool periodically — CMS updates the list about every 60 days.
  • Do not submit a revalidation application in PECOS until CMS publishes a concrete due date.

Verify on CMS Revalidation Lookup Tool

Prepare CMS-855 application → · Look up this NPI in PECOS → · Verify on CMS PECOS

Medicare Utilization (FFS)

Source: CMS public data · Not endorsed by CMS · Beneficiary counts under 11 are suppressed in source data ·

Educational use only—not medical, billing, or legal advice.

No Medicare fee-for-service utilization data available for this provider in our database.

Insurance plans in this area (ZIP 80308)

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Group practice members

Group practice members are other physicians who share the same Group Practice PAC ID with this doctor. When doctors form a group practice and register in PECOS as a single entity, they receive a shared identification number. This table lists all providers in the same group practice.
PAC ID: 4183520901View full group profile
NameSpecialtyState
Physical Therapist In Private PracticeCA
Physical Therapist In Private PracticeCA
-CA
Physical Therapist In Private PracticeCA
Physical Therapist In Private PracticeCA
-CA
-CA
-CA
Physical Therapist In Private PracticeCA

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Frequently asked questions

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Is DERRICK JOHN GRUEN (PT, DPT) active in the national directory?
DERRICK JOHN GRUEN (PT, DPT)'s public NPI profile is in an active state.
What kind of provider is DERRICK JOHN GRUEN (PT, DPT)?
The page reflects Physical Therapist for DERRICK JOHN GRUEN (PT, DPT). Clinical services aligned with this taxonomy classification.
What location metadata exists for DERRICK JOHN GRUEN (PT, DPT)?
The page summarizes Boulder, Colorado for DERRICK JOHN GRUEN (PT, DPT); expand the address list for detail.
What if Boulder, Colorado seems incomplete?
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