NPIMap

Individual provider Active NPI

Derek Guy Zickgraf, DO

  • Family Medicine Physician
  • Baker City, OR
National Provider Identifier
1568774362
Registry record updated Mar 29, 2017
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Medicine PhysicianTaxonomy code 207Q00000X
License
DO181773 Issued in OR
Practice address
3175 Pocahontas Rd
Baker City, OR 97814
Phone
(541) 523-4415
Fax
(541) 523-2399
NPI assigned
Jul 8, 2010
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Mar 29, 2017

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Family Medicine Physician 207Q00000X DO181773 OR Primary

Addresses

Primary practice location

3175 Pocahontas Rd
Baker City, OR 97814

Mailing address

3340 E Goldstone Way
Meridian, ID 83642-1026
Phone (541) 523-4415

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in OR
Eligible to order & refer
  • Part B services
  • Medical equipment
  • Home health
  • Power mobility devices
  • Hospice
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20170404002184 OR Practitioner - Family PracticePractitioner - Emergency Medicine 9436435583 Reassigns benefits to 4 organizations

Care Compare profile

Medicare Care Compare
Specialty
Family PracticeAlso: Emergency Medicine
Education
Other, 2010
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Blue Mountain Hospital DistrictGroup PAC ID 5193719219, 29 clinicians
Grande Ronde Hospital IncGroup PAC ID 0547170789, 97 clinicians

Practice addresses (Care Compare)

170 Ford Rd
John Day, OR 97845-2009
Phone (541) 575-1311

900 Sunset Dr
La Grande, OR 97850-1387
Phone (541) 963-8421

Hospital & facility affiliations

  • Blue Mountain Hospital Hospital, John Day, OR, CCN 381305
  • St. Alphonsus Medical Center - Baker City Hospital, Baker City, OR, CCN 381315
  • Grande Ronde Hospital Hospital, La Grande, OR, CCN 381321
  • Wallowa Memorial Hospital Hospital, Enterprise, OR, CCN 381306

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Doctor of Osteopathy

Practice roles

OrganizationSpecialtyStatusNew patients
Saint Alphonsus Medical Center Baker City, Inc Family Medicine CurrentSince Apr 1, 2017 Accepting new patients
Baker Clinic, LLP Current Accepting new patients
Grande Ronde Hospital, Inc. CurrentSince Sep 25, 2018 Accepting new patients
Grande Ronde Hospital, Inc. Family Medicine CurrentSince Sep 25, 2018 Accepting new patients
Saint Alphonsus Medical Center Baker City, Inc CurrentSince Apr 1, 2017 Accepting new patients

Locations

3340 E Goldstone Dr
Meridian, ID 83642
Phone (208) 302-9342

3820 17th St
Baker City, OR 97814
Phone (541) 523-2495

3325 Pocahontas Rd
Baker City, OR 97814
Phone (541) 523-1797

3175 Pocahontas Rd
Baker City, OR 97814
Phone (208) 302-2200

170 Ford Rd
John Day, OR 97845
Phone (541) 575-1311

900 Sunset Dr
La Grande, OR 97850
Phone (541) 963-8421

Interoperability endpoints

  • FHIR API: https://api.platform.athenahealth.com/1523/brand/1/csg/23/fhir/r4
  • Direct secure messaging: gzickgraf150433@direct.trinity-health.org

Organizations & group practices 6

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.

Hospital & facility affiliations 7

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

NPI Registry JSON

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

{
    "created_epoch": "1278547200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1490745600000",
    "number": "1568774362",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3340 E GOLDSTONE WAY",
            "city": "MERIDIAN",
            "state": "ID",
            "postal_code": "836421026",
            "telephone_number": "541-523-4415",
            "fax_number": "541-523-2399"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3175 POCAHONTAS RD",
            "city": "BAKER CITY",
            "state": "OR",
            "postal_code": "97814",
            "telephone_number": "541-523-4415",
            "fax_number": "541-523-2399"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "ZICKGRAF",
        "first_name": "DEREK",
        "middle_name": "GUY",
        "credential": "DO",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2010-07-08",
        "last_updated": "2017-03-29",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "OR",
            "license": "DO181773",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Baker City, OR

Sources for this page

Verify at the official NPI Registry.