Individual provider Active NPI

Derek Edward Weiss, PA-C

  • Physician Assistant
  • Camp Lejeune, NC
National Provider Identifier
1083147060
Registry record updated Oct 29, 2019
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physician AssistantTaxonomy code 363A00000X
Practice address
Naval Medical Center
100 Brewster Blvd
Camp Lejeune, NC 28547
Phone
(910) 450-4740
NPI assigned
Apr 6, 2017
Sex
Male
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Oct 29, 2019

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Physician Assistant 363A00000X Primary

Addresses

Primary practice location

Naval Medical Center
100 Brewster Blvd
Camp Lejeune, NC 28547

Mailing address

313 Hickory KNL
Hubert, NC 28539-4391
Phone (443) 603-3694

Other practice location 1

Naval Medical Center San Diego
34800 Bob Wilson Drive
San Diego, CA 92134-0001
Phone (443) 603-3694

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in DC
Eligible to order & refer
  • Part B services: Yes
  • Medical equipment: Yes
  • Home health: Yes
  • Power mobility devices: Yes
  • Hospice: No
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20211109000333 DC Practitioner - Physician Assistant 2264821529 Reassigns benefits to 1 organization

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Physician Assistant

Practice roles

OrganizationSpecialtyStatusNew patients
Emergency Medicine Associates P.a., P.C. CurrentSince Jun 1, 2024 Accepting new patients

Locations

15001 Health Center Dr
Bowie, MD 20716
Phone (301) 262-5511

1701 N George Mason Dr
Arlington, VA 22205
Phone (703) 558-5000

Interoperability endpoints

  • Direct secure messaging: dweiss848922@direct.umm.edu

Organizations & group practices 2

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.

NPI Registry JSON

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

{
    "created_epoch": "1491436800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1572307200000",
    "number": "1083147060",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "313 HICKORY KNL",
            "city": "HUBERT",
            "state": "NC",
            "postal_code": "285394391",
            "telephone_number": "443-603-3694"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "NAVAL MEDICAL CENTER",
            "address_2": "100 BREWSTER BLVD",
            "city": "CAMP LEJEUNE",
            "state": "NC",
            "postal_code": "28547",
            "telephone_number": "910-450-4740"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "Naval Medical Center San Diego",
            "address_2": "34800 Bob Wilson Drive",
            "address_purpose": "LOCATION",
            "city": "San Diego",
            "state": "CA",
            "postal_code": "921340001",
            "country_code": "US",
            "telephone_number": "443-603-3694",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "WEISS",
        "first_name": "DEREK",
        "middle_name": "EDWARD",
        "name_prefix": "Mr.",
        "credential": "PA-C",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2017-04-06",
        "last_updated": "2019-10-29",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Camp Lejeune, NC

Sources for this page

Verify at the official NPI Registry.