NPIMap

Individual provider Active NPI

Derek Berta

  • Physician Assistant
  • Idaho Falls, ID
National Provider Identifier
1114572716
Registry record updated Mar 17, 2026
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physician AssistantTaxonomy code 363A00000X
License
3371894 Issued in ID
Practice address
2860 Channing Way Ste 220
Idaho Falls, ID 83404-7541
Phone
(208) 800-6155
Fax
(208) 800-6158
NPI assigned
Aug 9, 2019
Last updated
Mar 17, 2026By the provider in NPPES
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Mar 17, 2026

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 3371894 ID Primary

Addresses

Primary practice location

2860 Channing Way Ste 220
Idaho Falls, ID 83404-7541

Mailing address

PO Box 277381
Atlanta, GA 30384-7381

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in SC, ID2 enrollments
Eligible to order & refer
  • Part B services
  • Medical equipment
  • Home health
  • Power mobility devices
  • Hospice
Green means eligible to order or refer.

Enrollment records 2

Enrollment IDStateProvider typePAC IDDetails
I20220526002382 SC Practitioner - Physician Assistant 5597174664 Reassigns benefits to 1 organization
I20260410001870 ID Practitioner - Physician Assistant 5597174664 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Physician Assistant
Education
Other, 2019
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Idaho Physician Services IncGroup PAC ID 2163430943, 18 clinicians
Musc Community PhysiciansGroup PAC ID 6507260668, 1,353 clinicians

Practice addresses (Care Compare)

2860 Channing Way
Suite 220
Idaho Falls, ID 83404-7541
Phone (208) 800-6155

506 N St
Bamberg, SC 29003-1319
Phone (803) 245-6290

Hospital & facility affiliations

Merit-based Incentive Payment System (MIPS)

Final score
80.41 of 100Reported as group
Quality
64.93
Promoting interoperability
99
Improvement activities
40

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
4293SCMDDentist
7866AZMDOccupational Therapist
3371894IDMDPhysician Assistant

Practice roles

OrganizationSpecialtyStatusNew patients
Musc Community Physicians CurrentSince Feb 4, 2022 Accepting new patients
Musc Community Physicians CurrentSince Feb 4, 2022 Accepting new patients
Idaho Physician Services Inc. Past Accepting new patients

Locations

506 North St
Bamberg, SC 29003
Phone (803) 245-6290

Interoperability endpoints

  • Direct secure messaging: dberta396086@direct.musc.edu

Organizations & group practices 4

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

Hospital & facility affiliations 5

Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.

NPI Registry JSON

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

{
    "created_epoch": "1565308800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1773705600000",
    "number": "1114572716",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 277381",
            "city": "ATLANTA",
            "state": "GA",
            "postal_code": "303847381"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2860 CHANNING WAY STE 220",
            "city": "IDAHO FALLS",
            "state": "ID",
            "postal_code": "834047541",
            "telephone_number": "208-800-6155",
            "fax_number": "208-800-6158"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "BERTA",
        "first_name": "DEREK",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2019-08-09",
        "last_updated": "2026-03-17",
        "certification_date": "2026-03-17",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "ID",
            "license": "3371894",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Idaho Falls, ID

Sources for this page

Verify at the official NPI Registry.