DR. TIMOTHY DERRICK DO (MD) – Neurological Surgery Physician, NPI 1043464639

DR. TIMOTHY DERRICK DO (MD) is a healthcare provider. based in Orange park, Florida. specializing in Neurological Surgery Physician. They hold the professional credentials MD. They hold a License No. 150583 (DC). The NPI Number for DR. TIMOTHY DERRICK DO (MD) is 1043464639

Main info

Male
21 Years Of Experience
Accepts Medicare Assignment
Name
DR. TIMOTHY DERRICK DO (MD)
NPI
1043464639
Phone
(904) 269-7007
Address
4689 US HIGHWAY 17
Enumeration Date
9 November 2008
Last Update Date
27 January 2022

Doctor Profile

Medical School Name
UNIVERSITY OF NORTH CAROLINA AT CHAPEL HILL SCHOOL OF MEDICINE
Secondary Phone
9042784447
Graduation Year
2005 (21 years ago)
PAC ID
3678713096
Group Practice PAC ID
4688723166
Professional Enrollment ID
I20130709000143

Contacts

Secure Messaging
TIMOTHY.DO@hca5.eclinicaldirectplus.com
Data current as of
20 May 2026

Profile Insights

NPPES metrics only — not quality of care.

Methodology
Experience57
Completeness85
Years active:17State licenses:2Other namesUpdated within 12 months

Provider Addresses for DR. TIMOTHY DERRICK DO (MD)

  • 4689 US HIGHWAY 17

    SUITE 11

    ORANGE PARK, FL 320034831

    Phone: (904) 269-7007

    Fax: (866) 264-0529

    Mailing address matches the actual address.

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: 2013-07-09

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
I20130709000143INeurologyFLTBD

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.

Top Medicare procedures (2023) · refreshed 2026-05-27

HCPCSDescriptionServicesBeneficiariesMedicare allowed
99215Established patient office or other outpatient visit, 40-54 minutes615298$0
95937Testing of nerve-muscle junction350141$0
95886Needle measurement of electrical activity in arm or leg muscles, complete study317143$0
95887Needle measurement of electrical activity in trunk or head muscles177144$0
99204New patient office or other outpatient visit, 45-59 minutes118118$0
View full utilization report →

Insurance plans in this area (ZIP 32003)

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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: 4688723166View full group profile
NameSpecialtyState
N E U R O L O G YNE
Neurology, Critical Care (Intensivists)FL

Reviews

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Frequently asked questions

Can I use this page to confirm DR. TIMOTHY DERRICK DO (MD)'s NPI?
Yes. DR. TIMOTHY DERRICK DO (MD) is listed with NPI 1043464639 in the public NPI dataset.
Does CMS list DR. TIMOTHY DERRICK DO (MD) as active?
Yes — DR. TIMOTHY DERRICK DO (MD) is active in the NPI listing used on this page.
What healthcare role does DR. TIMOTHY DERRICK DO (MD) hold?
Scheduling teams often label DR. TIMOTHY DERRICK DO (MD) under Neurological Surgery Physician. Clinical services aligned with this taxonomy classification.
What area does DR. TIMOTHY DERRICK DO (MD) serve?
DR. TIMOTHY DERRICK DO (MD)'s listing highlights Orange Park, Florida; more addresses can appear in NPPES.
Is the information about DR. TIMOTHY DERRICK DO (MD) up to date?
Data updates when providers file changes in NPPES — treat critical facts as "verify if unsure."

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