DERICK MOSTOLLER – Registered Nurse, NPI 1043818032

DERICK MOSTOLLER is a healthcare provider. based in Johnstown, Pennsylvania. specializing in CERTIFIED REGISTERED NURSE ANESTHETIST (CRNA). They hold a License No. RN674348 (PA). The NPI Number for DERICK MOSTOLLER is 1043818032

Main info

Male
6 Years Of Experience
Accepts Medicare Assignment
Name
DERICK MOSTOLLER
NPI
1043818032
Phone
(814) 534-9000
Address
1086 FRANKLIN ST
Enumeration Date
13 October 2020
Last Update Date
27 January 2022

Doctor Profile

Medical School Name
OTHER
Secondary Phone
8145349000
Graduation Year
2020 (6 years ago)
PAC ID
5799199824
Group Practice PAC ID
4688860455
Professional Enrollment ID
I20210201000081
Address ID
PA159054305JO1086XSTXX300
Data current as of
19 May 2026

Profile Insights

NPPES metrics only — not quality of care.

Methodology
Experience39
Completeness75
Years active:5State licenses:1Digital endpointsOther names

4,245 CERTIFIED REGISTERED NURSE ANESTHETIST (CRNA) in PA

Provider Addresses for DERICK MOSTOLLER

  • 1086 FRANKLIN ST

    JOHNSTOWN, PA 159054305

    Phone: (814) 534-9000

    Type: Location

  • 110 29TH AVE N STE 201

    NASHVILLE, TN 372031458

    Phone: (615) 327-4304

    Type: Mailing

  • 3900 E INDIANTOWN RD

    JUPITER, FL 334775085

    Phone:

    Type: Mailing

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: 2021-02-01

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
I20210201000081ICertified Registered Nurse Anesthetist (Crna)PATBD

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 15905)

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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: 4688860455View full group profile
NameSpecialtyState
Certified Registered Nurse Anesthetist (Crna)PA
A N E S T H E S I O L O G YNJ
A N E S T H E S I O L O G YPA
A N E S T H E S I O L O G YNY
Certified Registered Nurse Anesthetist (Crna)PA
Certified Registered Nurse Anesthetist (Crna)PA
A N E S T H E S I O L O G YNY
Certified Registered Nurse Anesthetist (Crna)TN
Certified Registered Nurse Anesthetist (Crna)PA
Certified Registered Nurse Anesthetist (Crna)PA

Reviews

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Frequently asked questions

What unique ID ties claims to DERICK MOSTOLLER?
NPI 1043818032 is assigned to DERICK MOSTOLLER under the national enumeration system.
Is DERICK MOSTOLLER active in the national directory?
DERICK MOSTOLLER's public NPI profile is in an active state.
What field does DERICK MOSTOLLER work in?
You can think of DERICK MOSTOLLER as practicing within Registered Nurse. Clinical services aligned with this taxonomy classification.
Does DERICK MOSTOLLER practice in Pennsylvania?
You will see Johnstown, Pennsylvania on file for DERICK MOSTOLLER alongside any extra practice locations.
Does Medicare enrollment show here?
Medicare enrollment screens are separate from the basic NPI extract shown here.

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