DR. DERRY DEAN JR. DYE (MD) – Pediatrics Physician, NPI 1215949599
Pediatrics Physician
Main info
Profile Insights
NPPES metrics only — not quality of care.
Provider Addresses for DR. DERRY DEAN JR. DYE (MD)
2210, Barron Road, Loma Linda, Poplar Bluff, Butler County, Missouri, 63901, United States
SUITE 120
POPLAR BLUFF, MO 639011908
Phone: (573) 785-2005
Fax: (573) 785-9444
Type: Mailing
225 PHYSICIANS PARK STE 400
POPLAR BLUFF, MO 639013923
Phone: (573) 727-5500
Fax: (573) 727-5599
Type: Location
PO BOX 801143
KANSAS CITY, MO 641801143
Phone: (573) 331-5583
Fax: (573) 331-5079
Type: Mailing
110 S 2ND ST
ELLINGTON, MO 636389400
Phone: (573) 663-2313
Fax: (573) 663-2441
Type: Mailing
225 PHYSICIANS PARK STE 200
POPLAR BLUFF, MO 639013921
Phone: (573) 727-5500
Fax: (573) 313-3684
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: 2019-08-29
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
- Medicare enrolled
- On CMS revalidation list
- Due date assigned
- Revalidate in PECOS
CMS enrollment records
| Enrollment ID | Type | Specialty | State | Due date |
|---|---|---|---|---|
| I20190829000171 | I | Pediatric Medicine | MO | TBD |
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.
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 63901)
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