Individual provider Active NPI

Derek James Bush, PA-C

  • Physician Assistant
  • Plattsburgh, NY
National Provider Identifier
1497375869
Registry record updated Feb 16, 2025
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physician AssistantTaxonomy code 363A00000X
Practice address
75 Beekman St
Plattsburgh, NY 12901-1427
Phone
(518) 562-7371
NPI assigned
Apr 25, 2020
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Feb 16, 2025

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 Primary

Addresses

Primary practice location

75 Beekman St
Plattsburgh, NY 12901-1427

Mailing address

75 Beekman St
Plattsburgh, NY 12901-1427
Phone (185) 627-3715

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in NY
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

Enrollment IDStateProvider typePAC IDDetails
I20210526002835 NY Practitioner - Physician Assistant 8123427069 Reassigns benefits to 2 organizations

Care Compare profile

Medicare Care Compare

Merit-based Incentive Payment System (MIPS)

Final score
85.28 of 100Reported as group
Quality
75.06
Promoting interoperability
100
Improvement activities
40
Cost
69.26

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
026302NYMDClinical Psychologist

Practice roles

OrganizationSpecialtyStatusNew patients
MVHS Inc CurrentSince May 15, 2021 Accepting new patients
Champlain Valley Physicians Hospital Medical Center Physician Assistant CurrentSince May 1, 2024 Accepting new patients
MVHS Inc CurrentSince May 15, 2021 Accepting new patients

Locations

1656 Champlin Ave
New Hartford, NY 13413
Phone (315) 624-6222

75 Beekman St
Plattsburgh, NY 12901
Phone (518) 562-7100

1676 Sunset Ave
Utica, NY 13502
Phone (315) 624-5567

111 Hospital Dr
Utica, NY 13502
Phone (315) 801-8534

Interoperability endpoints

  • Direct secure messaging: dbush582777@direct.uvmhealth.org
  • Direct secure messaging: dbush29008@mvhealthsystem.direct-ci.com

Organizations & group practices 3

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": "1587772800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1739664000000",
    "number": "1497375869",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "75 BEEKMAN ST",
            "city": "PLATTSBURGH",
            "state": "NY",
            "postal_code": "129011427",
            "telephone_number": "185-627-3715"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "75 BEEKMAN ST",
            "city": "PLATTSBURGH",
            "state": "NY",
            "postal_code": "129011427",
            "telephone_number": "518-562-7371"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "BUSH",
        "first_name": "DEREK",
        "middle_name": "JAMES",
        "credential": "PA-C",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2020-04-25",
        "last_updated": "2025-02-16",
        "certification_date": "2025-02-16",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Plattsburgh, NY

Sources for this page

Verify at the official NPI Registry.