Provider records sourced from NPPES (CMS National Plan & Provider Enumeration System). Data current as of August 10, 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
Claim this listing Report a problem Suggest an edit

Practice location Address checks out

4893 Transit Rd
Depew, NY 14043-4698
Phone: (716) 608-7040
Show map & directions

Directions in Google Maps · Apple Maps · OpenStreetMap

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
Mailing address1961 Bush Rd, Grand Island, NY 14072-2915

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

Other providers in Depew