Provider records sourced from NPPES (CMS National Plan & Provider Enumeration System). Data current as of October 4, 2026.
NPIDirectory

Derrick Schutrum

Individual provider Physician Assistant · NPI 1295350940

Derrick Schutrum is a Physician Assistant in Depew, New York. Qualified in 2019, 7 years ago. Practices with Southgate Medical Group LLP, a 32-clinician group and accepts Medicare assignment. Licensed in New York.

Years since qualifying
7
Licensed in
NY
In the registry since
2020
Specialties on file
2
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Practice location Address checks out

4893 Transit Rd
Depew, NY 14043-4698
Phone: (716) 608-7040
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Pin is approximate — placed at the ZIP-code centre, not the exact door.

Specialties & licences

Family Medicine Physician (primary) Taxonomy 207Q00000X · Licence 024885 (NY)
Physician Assistant Taxonomy 363A00000X (NY)

Record details

NPI number1295350940
Entity typeIndividual (Type 1)
GenderMale
Sole proprietorNo
NPI enumeratedJune 9, 2020
Last updated in NPPESJune 9, 2020
Certification dateJune 9, 2020

Medicare enrollment

From the CMS Doctors & Clinicians file — this clinician is enrolled in Medicare.

Medicare specialtyPHYSICIAN ASSISTANT
Medical schoolOTHER
Graduated 2019 (7 years in practice)
Group practice Southgate Medical Group Llp — 32 clinicians
Accepts Medicare assignment Yes — accepts the Medicare-approved amount
Practice locations2 on file with Medicare

Medicare patients and services, 2024

From the CMS Medicare Physician & Other Practitioners file for calendar year 2024. It counts Original Medicare patients only, so a practice that mostly sees Medicare Advantage or privately insured patients looks smaller here than it is.

Medicare patients106
Services billed 257 a service is one billed item, such as a visit, a test or a procedure
Average patient age69

Dollar amounts are not shown. What Medicare pays a practice is gross billings, before staff, premises and tax and including the cost of any drugs it administers, so it is not what a clinician earns.

Practises at

Facilities the CMS Facility Affiliation file lists for this clinician.

Colleagues at Southgate Medical Group LLP

Clinicians the CMS Doctors & Clinicians file lists under the same group practice. CMS counts 32 clinicians in the practice; 12 are shown here.

Other providers in Depew