NPIMap

Individual provider Active NPI

James P Derum, PA-C

  • Physician Assistant
  • Walnut Creek, CA
National Provider Identifier
1447355474
Registry record updated Apr 23, 2013
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physician AssistantTaxonomy code 363A00000X
License
PA16110 Issued in CA
Practice address
1990 N California Blvd Ste 400
Walnut Creek, CA 94596-7249
Phone
(925) 225-5837
Fax
(925) 225-5838
NPI assigned
Sep 14, 2006
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Apr 23, 2013

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 PA16110 CA Primary

Addresses

Primary practice location

1990 N California Blvd Ste 400
Walnut Creek, CA 94596-7249

Mailing address

67871 Valley Vista Dr
Cathedral City, CA 92234-2351
Phone (760) 668-0768

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Not listed in the public Medicare enrollment file

National Provider Directory

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

Practice roles

OrganizationSpecialtyStatusNew patients
Emergency Physicians Medical Group, Inc Past Accepting new patients
Memorial Emergency Physicians Medical Group, Inc Past Accepting new patients
Emergency Medicine Physician Partners of Rancho Mirage, Inc Past Accepting new patients
North Sonoma County Health Care District Past Accepting new patients

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 and National Provider Directory roles.

NPI Registry JSON

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

{
    "created_epoch": "1158192000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1366675200000",
    "number": "1447355474",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "67871 VALLEY VISTA DR",
            "city": "CATHEDRAL CITY",
            "state": "CA",
            "postal_code": "922342351",
            "telephone_number": "760-668-0768"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1990 N CALIFORNIA BLVD STE 400",
            "city": "WALNUT CREEK",
            "state": "CA",
            "postal_code": "945967249",
            "telephone_number": "925-225-5837",
            "fax_number": "925-225-5838"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "DERUM",
        "first_name": "JAMES",
        "middle_name": "P",
        "name_prefix": "Mr.",
        "credential": "PA-C",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-09-14",
        "last_updated": "2013-04-23",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "CA",
            "license": "PA16110",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Walnut Creek, CA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 23, 2013; 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.