Active NPI
Derek Burks, PHD
- Clinical Psychologist
- San Francisco, CA
National Provider Identifier
1033430830
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Clinical Psychologist
- License
- PY60123123
- Practice address
- 4150 Clement St
San Francisco, CA 94121-1563 - Phone
- (415) 221-4810
- NPI assigned
- Jun 15, 2010
- Sex
- Male
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 2
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Clinical Psychologist | 103TC0700X | 2666 | OR | |
| Clinical Psychologist | 103TC0700X | PY60123123 | WA | Primary |
Addresses
Primary practice location
4150 Clement St
San Francisco, CA 94121-1563
Mailing address
4150 Clement St
San Francisco, CA 94121-1563
Phone (415) 221-4810
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
- Credentials
- Doctor of Philosophy
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 2666 | OR | MD | Clinical Psychologist |
| PY60123123 | WA | MD | Clinical Psychologist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1276560000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1722384000000",
"number": "1033430830",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "4150 CLEMENT ST",
"city": "SAN FRANCISCO",
"state": "CA",
"postal_code": "941211563",
"telephone_number": "415-221-4810"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "4150 CLEMENT ST",
"city": "SAN FRANCISCO",
"state": "CA",
"postal_code": "941211563",
"telephone_number": "415-221-4810"
}
],
"practiceLocations": [],
"basic": {
"last_name": "BURKS",
"first_name": "DEREK",
"name_prefix": "Dr.",
"credential": "PHD",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2010-06-15",
"last_updated": "2024-07-31",
"certification_date": "2024-07-31",
"status": "A"
},
"taxonomies": [
{
"code": "103TC0700X",
"taxonomy_group": "",
"desc": "Psychologist, Clinical",
"state": "OR",
"license": "2666",
"primary": false
},
{
"code": "103TC0700X",
"taxonomy_group": "",
"desc": "Psychologist, Clinical",
"state": "WA",
"license": "PY60123123",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in San Francisco, CA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 31, 2024; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.