Derrek Giansiracusa

Public-record details

Address

11851 N 51st Ave Ste E130, Glendale, AZ 85304

Phone

(623) 299-9540

Listed under

Individual clinicians

NPI

1154023737

NPI status

Active in the NPPES registry

Provider type

Individual provider

Registered specialty (self-reported taxonomy)

Dermatology (207N00000X)

License number on NPI record

011498 (AZ)

NPI first issued

Mar 20, 2023

Years since NPI first issued

3 years (since 2023)

License state on NPI record

AZ

NPI record last updated

Mar 25, 2025

Medicare enrollment (CMS)

Enrolled: listed in CMS Doctors & Clinicians

Medicare assignment (CMS)

Accepts the Medicare-approved amount as payment in full

Professional school graduation (CMS)

2023 (3 years ago)

Professional school (CMS)

Lake Erie College of Osteopathic Medicine, Bradenton

Medicare group practice (CMS)

Omni Dermatology Incorporated (13 clinicians)

Practice locations on file with Medicare (CMS)

2

Other dermatology listings at this street address

5

NPI 1154023737 is active in the federal NPPES registry (CMS) with Dermatology as its self-reported primary taxonomy; license 011498 (AZ) is listed on the record. CMS Doctors & Clinicians lists this clinician as enrolled in Medicare. Source: NPPES NPI Registry (CMS) (record). Data as of 2026-10-16.

Public record, not an endorsement. This listing was compiled from public records as of 2026-10-16 and may be incomplete or out of date. Dermatologist Index does not vet, employ, recommend or guarantee dermatology practices; a badge reflects only what the public record showed on that date. Confirm current details with the official record before you decide. The information on Dermatologist Index is not medical advice and does not replace a doctor, nurse, discharge planner or other qualified professional. Do not use it to make decisions about diagnosis or treatment. If you have a medical emergency, call 911. Full disclaimer · Report an error

What these registry facts mean

The NPI (National Provider Identifier) is the federal ID every HIPAA-covered provider uses to bill insurance. This NPI belongs to an individual clinician. The specialty is the taxonomy the provider chose when registering; NPPES does not check it. A license number here is what the provider entered — confirm it with the state board before you rely on it. A registered specialty is not board certification. To check board certification, use the American Board of Dermatology's verification tool (or the American Osteopathic Board of Dermatology for DOs), and confirm the medical license with the state board.

View NPI 1154023737 in the official registry ↗

Practices and clinicians at this address

Other listings in this directory whose NPI record gives the same street address and ZIP. A shared address usually means a shared practice or building; it does not by itself show who works with whom.

• Lindsey Johnson, DO
• Rame Yousif, MD
• Caden Carver
• Bradley Boman, DO
• Omni Dermatology Incorporated (practice/organization)