Derrick Eugene Custino, M.D.

Primary specialty

Family Medicine PhysicianTaxonomy code 207Q00000X

License

MD22041 Issued in OR

Practice address

19400 NW Evergreen Pkwy
Hillsboro, OR 97124-7031

Phone

(503) 645-2762

Fax

(503) 690-5023

NPI assigned

Oct 16, 2006

Sex

Male

Sole proprietor

No

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Electronic endpoints 1

Medicare fee-for-service enrollment

Enrolled in OR, WA2 enrollments

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: Yes
• Power mobility devices: Yes
• Hospice: Yes

Green means eligible to order or refer.

Enrollment records 2

Specialty

Family Practice

Education

R Franklin University of Med & Sci/Chicago Medical School, 1996

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

Kaiser Foundation Health Plan of the NorthwestGroup PAC ID 5799688230, 1,805 clinicians

Practice addresses (Care Compare)

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Medicine

Practice roles

Locations

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

• Kaiser Foundation Health Plan of the Northwest

  • General Practice Physician
  • Portland, OR
  • NPI 1184786527

  Family Medicine, WA

  Medicare reassignment Care Compare group NPD
• Kaiser Foundation Health Plan of the Northwest

  • General Practice Physician
  • Portland, OR
  • NPI 1306192455

  Family Medicine

  NPD
• Kaiser Foundation Health Plan of the Northwest

  • Clinic/Center
  • Hillsboro, OR
  • NPI 1942718622
  NPD
• Kaiser Foundation Health Plan of the Northwest

  • General Practice Physician
  • Portland, OR
  • NPI 1982959565

  Family Medicine

  NPD

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1160956800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1643932800000",
    "number": "1013097146",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "19400 NW EVERGREEN PKWY",
            "city": "HILLSBORO",
            "state": "OR",
            "postal_code": "971247031",
            "telephone_number": "503-645-2762",
            "fax_number": "503-690-5023"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "19400 NW EVERGREEN PKWY",
            "city": "HILLSBORO",
            "state": "OR",
            "postal_code": "971247031",
            "telephone_number": "503-645-2762",
            "fax_number": "503-690-5023"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "CUSTINO",
        "first_name": "DERRICK",
        "middle_name": "EUGENE",
        "name_prefix": "Dr.",
        "credential": "M.D.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-10-16",
        "last_updated": "2022-02-04",
        "certification_date": "2022-02-04",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "OR",
            "license": "MD22041",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [
        {
            "endpointType": "SOAP",
            "endpointTypeDescription": "SOAP URL",
            "endpoint": "https://careepicwest.kp.org:14430/interconnect-prodnwm/wcf/epic.community.hie/xcpdrespondinggatewaysync.svc/ceq",
            "affiliation": "Y",
            "endpointDescription": "Carequality",
            "affiliationName": "Northwest Permanente PC",
            "use": "HIE",
            "useDescription": "Health Information Exchange (HIE)",
            "contentType": "OTHER",
            "contentTypeDescription": "Other",
            "contentOtherDescription": "C-CDA",
            "address_1": "10600 NE Evergreen Pkwy",
            "city": "Hillsboro",
            "state": "OR",
            "country_code": "US",
            "postal_code": "971247031",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

• Sandra R Curren, MSED
• Debra Currie, LAC
• Jennifer Leigh Currie, NP
• Stuart J Currie, M.D.
• Samantha Joyce Curtis
• Sarah Catherine D'Ambrosio, ANP-BC, WHNP-BC
• Ethan Ray Canlas Dado, DPT
• Lauren Beth Dahl, LCSW
• Nanette Elaine Dudley Dahlquist, M.D.
• Laura Elizabeth Daily

• Family Medicine Physician in Hillsboro, OR
• Providers in Hillsboro, OR by specialty
• Family Medicine Physician in Oregon

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 4, 2022; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.