Derek Foster Ipsen, D.O.

Primary specialty

Orthopaedic Hand Surgery PhysicianTaxonomy code 207XS0106X

License

O-1368 Issued in ID

Practice address

1 Jarrett White Rd
Tripler Army Medical Center
Tripler AMC, HI 96859-5001

Phone

(808) 433-2460

Fax

(808) 433-1558

NPI assigned

Jan 11, 2006

Sex

Male

Sole proprietor

No

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 2

Addresses

Other identifiers 1

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: Yes

Green means eligible to order or refer.

Enrollment records 1

Specialty

Orthopedic Surgery

Education

Kansas City University of Med & Biosciences, College of Osteo Med, 1999

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

St Lukes Clinic - Wood River LLCGroup PAC ID 3173783818, 66 clinicians

Practice addresses (Care Compare)

Hospital & facility affiliations

• St Luke'S Wood River Medical Center Hospital, Ketchum, ID, CCN 131323
• St Lukes Magic Valley Medical Center Hospital, Twin Falls, ID, CCN 130002

Procedures performed for Medicare patients

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Osteopathy

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 and National Provider Directory roles.

• St Lukes Clinic - Wood River LLC

  • Internal Medicine Physician
  • Ketchum, ID
  • NPI 1972891604

  Orthopaedic Surgery

  Medicare reassignment Care Compare group NPD

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

• St Lukes Wood River Medical Center LTD

  • Critical Access Hospital
  • Ketchum, ID
  • NPI 1508869470
  Care Compare affiliation
• St. Luke'S Magic Valley Regional Medical Center, LTD.

  • General Acute Care Hospital
  • Twin Falls, ID
  • NPI 1932154705
  Care Compare affiliation

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

{
    "created_epoch": "1136937600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1624924800000",
    "number": "1477532299",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1 JARRETT WHITE RD",
            "address_2": "TRIPLER ARMY MEDICAL CENTER ATTN: MCHK-QS",
            "city": "TRIPLER AMC",
            "state": "HI",
            "postal_code": "968595001",
            "telephone_number": "808-433-2460",
            "fax_number": "808-433-1558"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1 JARRETT WHITE RD",
            "address_2": "TRIPLER ARMY MEDICAL CENTER",
            "city": "TRIPLER AMC",
            "state": "HI",
            "postal_code": "968595001",
            "telephone_number": "808-433-2460",
            "fax_number": "808-433-1558"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "IPSEN",
        "first_name": "DEREK",
        "middle_name": "FOSTER",
        "name_prefix": "Dr.",
        "credential": "D.O.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-01-11",
        "last_updated": "2021-06-29",
        "certification_date": "2021-06-29",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207X00000X",
            "taxonomy_group": "",
            "desc": "Orthopaedic Surgery",
            "state": "MO",
            "license": "2001004848",
            "primary": false
        },
        {
            "code": "207XS0106X",
            "taxonomy_group": "",
            "desc": "Orthopaedic Surgery, Hand Surgery",
            "state": "ID",
            "license": "O-1368",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1477532299",
            "state": "MO"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Linda Garrett Humes, FNP
• Phat Nguyen Huynh
• Veronica Icaza Galindo, MD
• Jerry V Iloreta
• Walter K. Imai, M.D.
• Eileen C Itamoto-Gaza, OTR
• Amanda M Jackson, M.D.
• Kerry Erin Jaime, MD
• Larry Charles James, PH.D.
• Samuel S Jang, D. O., MPH

• Orthopaedic Hand Surgery Physician in Tripler AMC, HI
• Providers in Tripler AMC, HI by specialty
• Orthopaedic Hand Surgery Physician in Hawaii

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 29, 2021; 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.