Derek Eddie, PA-C

Primary specialty

Medical Physician AssistantTaxonomy code 363AM0700X

License

PA-662 Issued in ID

Practice address

560 Memorial Dr
Pocatello, ID 83201-4073

Phone

(208) 234-1960

Fax

(208) 233-5033

NPI assigned

Feb 22, 2007

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

Medicare fee-for-service enrollment

Enrolled in ID

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

Physician Assistant

Education

Other, 2006

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

CC Pocatello LLCGroup PAC ID 8527353176, 7 clinicians

Practice addresses (Care Compare)

Hospital & facility affiliations

• Enhabit Home Health of Eastern Idaho Home health agency, Idaho Falls, ID, CCN 137105
• Mountain View Hospital Hospital, Idaho Falls, ID, CCN 130065
• Portneuf Medical Center Hospital, Pocatello, ID, CCN 130028

Medicare enrollment (NPD)

Enrolled

Credentials

Physician Assistant

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 and National Provider Directory roles.

• CC Pocatello LLC

  • Family Medicine Physician
  • Pocatello, ID
  • NPI 1538517156
  Medicare reassignment Care Compare group
• Mountain View Hospital LLC

  • General Acute Care Hospital
  • Idaho Falls, ID
  • NPI 1669462362
  Medicare reassignment NPD
• Community Care Pocatello PLLC

  • Urgent Care Clinic/Center
  • Pocatello, ID
  • NPI 1265714760
  NPD
• Mountain View Hospital Physician Organization

  • General Acute Care Hospital
  • Idaho Falls, ID
  • NPI 1073834529
  NPD (past)

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

• Eh Home Health of the West, LLC

  • Home Health Agency
  • Idaho Falls, ID
  • NPI 1700167400
  Care Compare affiliation
• Mountain View Hospital LLC

  • General Acute Care Hospital
  • Idaho Falls, ID
  • NPI 1669462362
  Care Compare affiliation
• Pocatello Hospital LLC

  • Rehabilitation Hospital Unit
  • Pocatello, ID
  • NPI 1144262114
  Care Compare affiliation
• Pocatello Hospital LLC

  • General Acute Care Hospital
  • Pocatello, ID
  • NPI 1790751055
  Care Compare affiliation

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

{
    "created_epoch": "1172102400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1183852800000",
    "number": "1346375367",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "560 MEMORIAL DR",
            "city": "POCATELLO",
            "state": "ID",
            "postal_code": "832014073",
            "telephone_number": "208-234-1960",
            "fax_number": "208-233-5033"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "560 MEMORIAL DR",
            "city": "POCATELLO",
            "state": "ID",
            "postal_code": "832014073",
            "telephone_number": "208-234-1960",
            "fax_number": "208-233-5033"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "EDDIE",
        "first_name": "DEREK",
        "credential": "PA-C",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2007-02-22",
        "last_updated": "2007-07-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363AM0700X",
            "taxonomy_group": "",
            "desc": "Physician Assistant, Medical",
            "state": "ID",
            "license": "PA-662",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Faith Marie Eastwod
• Lindsay Hibbard Eborn
• Becki Lee Echavez Cheek, LCSW
• William Eckersell, LCPC
• Ed Snell'S Pharmacy Shop
• Dellisa Dawn Eddington, NP-C
• Ronda Edgley, NP
• Edward a Desano Jr MD PA
• Edwards Enterprises LLC
• Eh Hospice of the West, LLC

• Medical Physician Assistant in Pocatello, ID
• Providers in Pocatello, ID by specialty
• Medical Physician Assistant in Idaho

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 8, 2007; 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.