Derek Prine

Primary specialty

Pulmonary Function Technologist Registered Respiratory TherapistTaxonomy code 2279P1006X

License

27699 Issued in CA

Practice address

1427 69TH Ave
Oakland, CA 94621-3456

Phone

(209) 485-2848

NPI assigned

Aug 17, 2020

Last updated

Nov 21, 2022By the provider in NPPES

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

Other identifiers 1

Electronic endpoints 1

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

State licenses

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

{
    "created_epoch": "1597622400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1668988800000",
    "number": "1144832718",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1427 69TH AVE",
            "city": "OAKLAND",
            "state": "CA",
            "postal_code": "946213456"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1427 69TH AVE",
            "city": "OAKLAND",
            "state": "CA",
            "postal_code": "946213456",
            "telephone_number": "209-485-2848"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "PRINE",
        "first_name": "DEREK",
        "name_prefix": "Mr.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2020-08-17",
        "last_updated": "2022-11-21",
        "certification_date": "2022-11-21",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "2279P1006X",
            "taxonomy_group": "",
            "desc": "Respiratory Therapist, Registered, Pulmonary Function Technologist",
            "state": "CA",
            "license": "27699",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "CALIFORNIA BOARD OF RESPIRATORY CARE LICENSE",
            "identifier": "27699",
            "state": "CA"
        }
    ],
    "endpoints": [
        {
            "endpointType": "SOAP",
            "endpointTypeDescription": "SOAP URL",
            "endpoint": "https://careepicwest.kp.org:14430/Interconnect-prodcalgateway/wcf/epic.community.hie/xcpdrespondinggatewaysync.svc/ncalceq",
            "affiliation": "Y",
            "endpointDescription": "Carequality",
            "affiliationName": "The Permanente Medical Group",
            "use": "HIE",
            "useDescription": "Health Information Exchange (HIE)",
            "contentType": "OTHER",
            "contentTypeDescription": "Other",
            "contentOtherDescription": "C-CDA",
            "address_1": "3600 Broadway",
            "city": "Oakland",
            "state": "CA",
            "country_code": "US",
            "postal_code": "946115730",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

• Prime Medical Associates, Inc.
• La Juana Monique Prince-Vaughn
• Kailah Prince
• McCaul Elizabeth Prince
• Princeton Manor Healthcare Center LLC
• Alma G Prins, MSW, LCSW
• Jonna Prinzing
• Prism Psychotherapy LLC
• Saraa Sadellia Pritchard-Olawore
• Joely Pritzker, NP-C

• Registered Respiratory Therapist in Oakland, CA
• Providers in Oakland, CA by specialty
• Registered Respiratory Therapist in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 21, 2022; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.