NPIMap

Individual provider Active NPI

Cameron E Derbyshire, P.A.

  • Medical Physician Assistant
  • Springfield, OR
National Provider Identifier
1609130269
Registry record updated Sep 28, 2022
On this page

Key facts

NPPES NPI Registry
Primary specialty
Medical Physician AssistantTaxonomy code 363AM0700X
License
PA158631 Issued in OR
Practice address
2400 Hartman LN Ste 100
Springfield, OR 97477-1119
Phone
(541) 334-3350
Fax
(541) 746-4569
NPI assigned
Jun 28, 2012
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Sep 28, 2022

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Medical Physician Assistant 363AM0700X PA158631 OR Primary

Addresses

Primary practice location

2400 Hartman LN Ste 100
Springfield, OR 97477-1119

Mailing address

PO Box 24410
Eugene, OR 97402-0451
Phone (541) 997-7134

Other practice location 1

380 9th St
Florence, OR 97439-9470
Phone (541) 997-7134

Other identifiers 1

IdentifierTypeStateIssuer
500646843MedicaidOR

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
I20120726000503 OR Practitioner - Physician Assistant 7012173636 Reassigns benefits to 4 organizations

Care Compare profile

Medicare Care Compare
Specialty
Physician Assistant
Education
Other, 2012
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Telehealth
Offers telehealth services
Group practices
Oregon Urology Institute PCGroup PAC ID 6608766399, 33 clinicians

Practice addresses (Care Compare)

1007 Harlow Rd
FL 3
Springfield, OR 97477-7124
Phone (541) 334-3350

2400 Hartman LN
Springfield, OR 97477-1118
Phone (541) 334-3350

2400 Hartman LN
Suite 200
Springfield, OR 97477-1122

Hospital & facility affiliations

  • Peace Harbor Medical Center Hospital, Florence, OR, CCN 381316
  • Sacred Heart Medical Center - Riverbend Hospital, Springfield, OR, CCN 380102
  • Mercy Medical Center Hospital, Roseburg, OR, CCN 380027
  • Bay Area Hospital Hospital, Coos Bay, OR, CCN 380090
  • Peacehealth Cottage Grove Community Medical Center Hospital, Cottage Grove, OR, CCN 381301

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
PA158631ORMDMedical Physician Assistant

Practice roles

OrganizationSpecialtyStatusNew patients
Peacehealth CurrentSince Jul 1, 2012 Accepting new patients
Peacehealth Medical Group CurrentSince Jan 12, 2023 Accepting new patients

Locations

4010 Aerial Way
Eugene, OR 97402
Phone (541) 242-8300

390 9th St
Florence, OR 97439
Phone (541) 997-7134

400 9th St
Florence, OR 97439
Phone (541) 997-8412

380 9th St
Florence, OR 97439
Phone (541) 997-7134

1115 SE 164th Ave
Dept 358
Vancouver, WA 98683
Phone (360) 729-1253

Interoperability endpoints

  • Direct secure messaging: cderbyshire2302@direct.peacehealth.org
  • Direct secure messaging: cderbysh@yourcarecommunity.org

Organizations & group practices 5

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 6

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": "1340841600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1664323200000",
    "number": "1609130269",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 24410",
            "city": "EUGENE",
            "state": "OR",
            "postal_code": "974020451",
            "telephone_number": "541-997-7134",
            "fax_number": "541-997-9650"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2400 HARTMAN LN STE 100",
            "city": "SPRINGFIELD",
            "state": "OR",
            "postal_code": "974771119",
            "telephone_number": "541-334-3350",
            "fax_number": "541-746-4569"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "380 9th St",
            "address_purpose": "LOCATION",
            "city": "Florence",
            "state": "OR",
            "postal_code": "974399470",
            "country_code": "US",
            "telephone_number": "541-997-7134",
            "fax_number": "541-997-9650",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "DERBYSHIRE",
        "first_name": "CAMERON",
        "middle_name": "E",
        "credential": "P.A.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2012-06-28",
        "last_updated": "2022-09-28",
        "certification_date": "2022-09-28",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363AM0700X",
            "taxonomy_group": "",
            "desc": "Physician Assistant, Medical",
            "state": "OR",
            "license": "PA158631",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "500646843",
            "state": "OR"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Springfield, OR

Sources for this page

Verify at the official NPI Registry.