Derek Brent Kordenbrock, NP

Primary specialty

Adult Health Nurse PractitionerTaxonomy code 363LA2200X

License

201604376NP-PP Issued in OR

Practice address

1345 Center Dr Unit a
Medford, OR 97501-7945

Phone

(541) 734-9030

Fax

(541) 734-9885

NPI assigned

Feb 7, 2013

Last updated

Mar 20, 2023By 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 4

Addresses

Medicare fee-for-service enrollment

Enrolled in OR

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

Specialty

Nurse Practitioner

Education

University of California, San Francisco School of Medicine, 2012

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

Valley Immediate Care, LLCGroup PAC ID 7618876723, 36 clinicians

Practice addresses (Care Compare)

Medicare enrollment (NPD)

Enrolled

Credentials

Nurse Practitioner

State licenses

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, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

• Valley Immediate Care, LLC

  • Urgent Care Clinic/Center
  • Medford, OR
  • NPI 1982709226
  Medicare reassignment Care Compare group NPD

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

{
    "created_epoch": "1360195200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1679270400000",
    "number": "1245579408",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "815 N CENTRAL AVE STE C",
            "city": "MEDFORD",
            "state": "OR",
            "postal_code": "975015873",
            "telephone_number": "541-734-9030",
            "fax_number": "541-734-9885"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1345 CENTER DR UNIT A",
            "city": "MEDFORD",
            "state": "OR",
            "postal_code": "975017945",
            "telephone_number": "541-734-9030",
            "fax_number": "541-734-9885"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "KORDENBROCK",
        "first_name": "DEREK",
        "middle_name": "BRENT",
        "name_prefix": "Mr.",
        "credential": "NP",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2013-02-07",
        "last_updated": "2023-03-20",
        "certification_date": "2023-03-20",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LA2200X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Adult Health",
            "state": "CA",
            "license": "22446",
            "primary": false
        },
        {
            "code": "363LA2200X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Adult Health",
            "state": "OR",
            "license": "201604376NP-PP",
            "primary": true
        },
        {
            "code": "363LX0106X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Occupational Health",
            "state": "OR",
            "license": "201604376NP-PP",
            "primary": false
        },
        {
            "code": "363LX0106X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Occupational Health",
            "state": "CA",
            "license": "22446",
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Apoorva Kondapally, MD
• Cindy Ann Konecne, DO
• Christine Konya, MD
• Julia Caroline Koon, QMHP
• Jaclyn Estelle Koran, QMHP, CADC-R
• Michael Allen Korpa, D.O., M.P.H.
• Matthew Brian Kosak Jr., NP
• Julia Katherina Kostka, MD
• Kamal Kotaich
• Todd S Kotler, M.D.

• Adult Health Nurse Practitioner in Medford, OR
• Providers in Medford, OR by specialty
• Adult Health Nurse Practitioner in Oregon

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 20, 2023; 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.