Annie Derthick, PHD - Medicare Psychologist in Kennesaw, GA

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Annie Derthick, PHD is a medicare enrolled "Psychologist - Clinical" provider in Kennesaw, Georgia. Her current practice location is 4255 Wade Green Rd Nw Ste 414, Kennesaw, Georgia. You can reach out to her office (for appointments etc.) via phone at (678) 213-2194.

Annie Derthick is licensed to practice in Georgia (license number PSY900357) and she also participates in the medicare program. She does not accept medicare assignments directly but she may accept medicare through third-party (refer to Reassignment section below) and may also prescribe medicare part D drugs. Her NPI Number is 1689039422.

Contact Information

Annie Derthick, PHD
4255 Wade Green Rd Nw Ste 414,
Kennesaw, GA 30144-1763
(678) 213-2194
Not Available

Map and Direction




Healthcare Provider's Profile

Full NameAnnie Derthick
GenderFemale
SpecialityPsychologist - Clinical
Location4255 Wade Green Rd Nw Ste 414, Kennesaw, Georgia
Accepts Medicare AssignmentsMedicare enrolled and may accept medicare through third-party reassignment. May prescribe medicare part D drugs.
  NPI Data:
  • NPI Number: 1689039422
  • Provider Enumeration Date: 12/21/2015
  • Last Update Date: 08/18/2026
  Medicare PECOS Information:
  • PECOS PAC ID: 2567769391
  • Enrollment ID: I20200227002274

Medical Identifiers

Medical identifiers for Annie Derthick such as npi, medicare ID, medicare PIN, medicaid, etc.
IdentifierTypeStateIssuer
1689039422NPI-NPPES

Medical Taxonomies and Licenses

TaxonomyTypeLicense (State)Status
103TF0000XPsychologist - Family PS1563 (Maine)Secondary
103T00000XPsychologist 107779 (Alaska)Secondary
103TC0700XPsychologist - Clinical PSY900357 (Georgia)Primary

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. Annie Derthick allows following entities to bill medicare on her behalf.
Entity NameCentral Maine Medical Center
Entity TypePart B Supplier - Clinic/group Practice
Entity IdentifiersNPI Number: 1689653487
PECOS PAC ID: 2567379563
Enrollment ID: O20040324000441

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. Annie Derthick 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
Annie Derthick, PHD
4800 N Scottsdale Rd Ste 2500,
Scottsdale, AZ 85251-7630

Ph: Not Available		Annie Derthick, PHD
4255 Wade Green Rd Nw Ste 414,
Kennesaw, GA 30144-1763

Ph: (678) 213-2194

Reviews and Comments


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Medicare Program: Medicare is a federal government program which provides health insurance to people who are 65 or older. This program also covers certain younger people with disabilities (who receive Social Security Disability Insurance - SSDI), and people with End-Stage Renal Disease (permanent kidney failure requiring dialysis or a transplant, sometimes called ESRD.

Medicare Assignment: Assignment means that your doctor, provider, or supplier agrees (or is required by law) to accept the Medicare-approved amount as full payment for covered services. Most doctors, providers, and suppliers accept assignment, but you should always check to make sure. Participating providers have signed an agreement to accept assignment for all Medicare-covered services.

NPI Number: The National Provider Identifier (NPI) is a unique identification number for covered health care providers. The NPI must be used in lieu of legacy provider identifiers in the HIPAA standards transactions. Covered health care providers and all health plans and health care clearinghouses must use the NPIs in the administrative and financial transactions adopted under HIPAA (Health Insurance Portability and Accountability Act).

Our Data: Information on www.medicarelist.com is built using data sources published by Centers for Medicare & Medicaid Services (CMS) under Freedom of Information Act (FOIA). The information disclosed on the NPI Registry are FOIA-disclosable and are required to be disclosed under the FOIA and the eFOIA amendments to the FOIA. There is no way to 'opt out' or 'suppress' the NPPES record data for health care providers with active NPIs.