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Deactivated NPI 1972505477 Deactivated / Inactive NPI Male Practitioner

Dr. John C. Derickson , OD

Optometrist • Jacksonville, FL

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Notice of NPI Deactivation & Inactive Practice Status

According to official public domain records published by CMS (Centers for Medicare & Medicaid Services) in the National Provider Identifier (NPPES) Registry, Dr. John Derickson has officially deactivated this NPI record and ceased active healthcare practice.

Registration / Start Date August 15, 2005
NPI Deactivation Date March 22, 2006
Total Practice Duration ~1 Years of Practice (2005 – 2006)

Professional Overview & Biography Verified Profile Summary

Dr. John Derickson, OD was a registered Optometrist practicing in Jacksonville, FL. Throughout an active medical career spanning 1 years, Dr. Derickson provided care at the practice location at 8771 PERIMETER PARK CT until profile deactivation on 2006-03-22.

Historical Medicare Part B clinical services included photography of the retina, new patient complete exam of visual system. Public procedure reimbursement records and service volume details are provided below for historical transparency.

Practice Location & Contact Primary Location

Practice Address

8771 Perimeter Park Ct
Suite 101

Jacksonville, FL 322166396

Telephone 9049978585
Fax 9049980054
Associated Practice Facility / Clinic
🏢 John C. Derickson Od, Pa Facility NPI 1356686976

Specialty Benchmarks & Practice Insights

Comparative analytics for Optometrist in Jacksonville, FL

Active Practitioner
Practitioner Clinical Experience
Active
City Avg: 20.6 Yrs
State Avg: 22.7 Yrs
Regional Practice Density
180 Specialists

Practicing in Jacksonville, FL (3724 Statewide)

Telehealth Adoption Rate
0.0% Regional Adoption

In-Person Office Visits Only

Medicare Pricing Discount
12.5% Avg Savings

Under CMS Medicare Fee Schedule vs Standard Submitted Charges

Performed Procedures & Service Volume

Top Medicare Part B procedures performed by this practitioner

CMS Official Data (2018)
HCPCS Code & Description Services Patients Submitted Charge Medicare Allowed
92250 Photography of the retina
14 14 $60.00 $51.29
92004 New patient complete exam of visual system
11 11 $155.00 $136.76

Medical Specialties & State Licenses

Optometrist Primary Specialty

NUCC Taxonomy Code: 152W00000X

State License FL OPC3107

Doctors of optometry (ODs) are the primary health care professionals for the eye. Optometrists examine, diagnose, treat, and manage diseases, injuries, and disorders of the visual system, the eye, and associated structures as well as identify related systemic conditions affecting the eye. An optometrist has completed pre-professional undergraduate education in a college or university and four years of professional education at a college of optometry, leading to the doctor of optometry (O.D.) degree. Some optometrists complete an optional residency in a specific area of practice. Optometrists are eye health care professionals state-licensed to diagnose and treat diseases and disorders of the eye and visual system.

Practice Associates & Co-Workers

Healthcare professionals and specialists practicing at this location or sharing practice phone/fax

1 Associated Practitioners
Matthew Sutton

Optometrist

NPI 1245616317

Career & Practice History Timeline

Chronological log of verified NPI updates, location relocations, credentials, and registry changes

8 Historical Events
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NPI Profile Deactivated November 04, 2021

Record deactivated on November 04, 2021

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Updated Practice Location December 12, 2008

Registered at 8771 PERIMETER PARK CT, SUITE 101, JACKSONVILLE, FL 322166396 (Tel: 9049978585)

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Updated Business Mailing Address December 12, 2008

Registered at 8771 PERIMETER PARK CT, SUITE 101, JACKSONVILLE, FL 322166396 (Tel: 9049978585)

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Provider Name / Credentials Updated December 12, 2008

Recorded as JOHN DERICKSON, O.D.

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Medical Taxonomy / Specialty Registered (Primary Specialty) December 12, 2008

Optometrist (License #OPC3107 in FL)

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NPI Profile Reactivated April 10, 2006

Record officially reactivated for active practice on April 10, 2006

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NPI Profile Deactivated March 22, 2006

Record deactivated on March 22, 2006

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Initial NPI Registration & Enumeration August 15, 2005

First registered as active Individual Practitioner in NPPES Database.

Patient & Community Reviews

Verified patient ratings, medical care experiences, and facility photos

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NPI Administrative Meta

NPI Number: 1972505477
Entity Type:
Individual Provider Physician, Nurse Practitioner, or Solo Healthcare Professional (Type 1 NPI)
Enumeration Date: August 15, 2005
Last Update: December 12, 2008
Deactivation Date: March 22, 2006

Mailing Address

8771 Perimeter Park Ct, Suite 101

Jacksonville, FL 322166396

Phone: 9049978585

Public Domain Record This profile contains public domain information published by CMS and NPPES under the Freedom of Information Act (FOIA).
⚠️ Medical Disclaimer

This directory listing is for informational purposes only and does not constitute medical advice, diagnosis, or physician endorsement. If you are experiencing a medical emergency, please call 911 immediately.