Derek Joseph Davenport, MD - Medicare Pediatric Medicine in Eagle Mountain, UT

Derek Joseph Davenport, MD is a medicare enrolled "Pediatrics" physician in Eagle Mountain, Utah. He graduated from medical school in 2009 and has 15 years of diverse experience with area of expertise as Pediatric Medicine. He is a member of the group practice Central Utah Clinic Pc and his current practice location is 4095 E Pony Express Pkwy Ste 1, Eagle Mountain, Utah. You can reach out to his office (for appointments etc.) via phone at (801) 429-8037.

Derek Joseph Davenport is licensed to practice in Utah (license number 11327523-1205) and he also participates in the medicare program. He accepts medicare assignments (which means he accepts the Medicare-approved amount; you will not be billed for any more than the Medicare deductible and coinsurance) and his NPI Number is 1346484581.

Contact Information

Derek Joseph Davenport, MD
4095 E Pony Express Pkwy Ste 1,
Eagle Mountain, UT 84005-5531
(801) 429-8037
(801) 753-7476



Physician's Profile

Full NameDerek Joseph Davenport
GenderMale
SpecialityPediatric Medicine
Experience15 Years
Location4095 E Pony Express Pkwy Ste 1, Eagle Mountain, Utah
Accepts Medicare AssignmentsYes. He accepts the Medicare-approved amount; you will not be billed for any more than the Medicare deductible and coinsurance.
  Medical Education and Training:
  • Derek Joseph Davenport graduated from medical school in 2009
  NPI Data:
  • NPI Number: 1346484581
  • Provider Enumeration Date: 04/30/2009
  • Last Update Date: 11/27/2023
  Medicare PECOS Information:
  • PECOS PAC ID: 7911140058
  • Enrollment ID: I20191205001032

Medical Identifiers

Medical identifiers for Derek Joseph Davenport such as npi, medicare ID, medicare PIN, medicaid, etc.
IdentifierTypeStateIssuer
1346484581NPI-NPPES
1346484581OtherNPI
500659989MedicaidOR

Medical Taxonomies and Licenses

TaxonomyTypeLicense (State)Status
207R00000XInternal Medicine 11327523-1205 (Utah)Secondary
207R00000XInternal Medicine MD162235 (Oregon)Secondary
208000000XPediatrics MD162235 (Oregon)Secondary
208000000XPediatrics 11327523-1205 (Utah)Primary

Group Practice Association

Group Practice NameGroup PECOS PAC IDNo. of Members
Central Utah Clinic Pc7517868508391

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Medicare Reassignments

Some practitioners may not bill the customers directly but medicare billing happens through clinics / group practice / hospitals where the provider works. Medicare reassignment of benefits is a mechanism by which practitioners allow third parties to bill and receive payment for medicare services performed by them. Derek Joseph Davenport allows following entities to bill medicare on his behalf.
Entity NameCentral Utah Clinic Pc
Entity TypePart B Supplier - Clinic/group Practice
Entity IdentifiersNPI Number: 1093764805
PECOS PAC ID: 7517868508
Enrollment ID: O20040113000805

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Medicare Part D Prescriber Enrollment

Any physician or other eligible professional who prescribes Part D drugs must either enroll in the Medicare program or opt out in order to prescribe drugs to their patients with Part D prescription drug benefit plans. Derek Joseph Davenport is enrolled with medicare and thus, if eligible, can prescribe medicare part D drugs to patients with medicare part D benefits.

Mailing Address and Practice Location

Mailing AddressPractice Location Address
Derek Joseph Davenport, MD
1055 N 500 W, Attn. Credentialing,
Provo, UT 84604

Ph: (801) 354-8225
Derek Joseph Davenport, MD
4095 E Pony Express Pkwy Ste 1,
Eagle Mountain, UT 84005-5531

Ph: (801) 429-8037

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Pediatrics Doctors in Eagle Mountain, UT


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