Derrick Kyle Pelton, NP

Primary specialty

Family Nurse PractitionerTaxonomy code 363LF0000X

License

95012148 Issued in CA

Practice address

3883 Airway Dr Ste 120
Santa Rosa, CA 95403-1678

Phone

(707) 521-4495

Fax

(707) 573-5421

NPI assigned

Aug 5, 2013

Sex

Male

Sole proprietor

No

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

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Enrolled in CA

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

Specialty

Nurse Practitioner

Education

Other, 2013

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

Sutter Bay Medical FoundationGroup PAC ID 4284538778, 3,783 clinicians

San Francisco Emergency Medical AssociatesGroup PAC ID 5698662518, 74 clinicians

Practice addresses (Care Compare)

Hospital & facility affiliations

• Sutter Santa Rosa Regional Hospital Hospital, Santa Rosa, CA, CCN 050291

Medicare enrollment (NPD)

Enrolled

Credentials

Nurse Practitioner

Practice roles

Locations

Interoperability endpoints

• Direct secure messaging: dpelton462766@hisp.ehr.sutterhealth.org

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.

• San Francisco Emergency Medical Associates

  • Emergency Medicine Physician
  • San Francisco, CA
  • NPI 1134110661
  Medicare reassignment Care Compare group NPD
• Sutter Bay Medical Foundation

  • Multi-Specialty Clinic/Center
  • Palo Alto, CA
  • NPI 1013950807
  Medicare reassignment Care Compare group NPD
• Sutter Bay Medical Foundation

  • Multi-Specialty Clinic/Center
  • Sacramento, CA
  • NPI 1003267196
  NPD
• Sutter Bay Medical Foundation

  • Clinical Medical Laboratory
  • Santa Clara, CA
  • NPI 1669287033
  NPD
• Sutter Bay Hospitals

  • Medicare Defined Swing Bed Hospital Unit
  • Lakeport, CA
  • NPI 1598098642
  NPD (past)
• Sutter Bay Hospitals

  • General Acute Care Hospital
  • Santa Rosa, CA
  • NPI 1740413798
  NPD (past)
• Banner Pharmacy Services LLC

  • Community/Retail Pharmacy
  • Tucson, AZ
  • NPI 1154384899
  NPD (past)
• University Physicians Healthcare

  • General Acute Care Hospital
  • Tucson, AZ
  • NPI 1104887199
  NPD (past)

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

• Sutter Bay Hospitals

  • General Acute Care Hospital
  • Santa Rosa, CA
  • NPI 1740413798
  Care Compare affiliation

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

{
    "created_epoch": "1375660800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1644364800000",
    "number": "1609208354",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "325 DISTEL CIR",
            "city": "LOS ALTOS",
            "state": "CA",
            "postal_code": "940221408",
            "telephone_number": "707-521-4495",
            "fax_number": "707-573-5421"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3883 AIRWAY DR STE 120",
            "city": "SANTA ROSA",
            "state": "CA",
            "postal_code": "954031678",
            "telephone_number": "707-521-4495",
            "fax_number": "707-573-5421"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "PELTON",
        "first_name": "DERRICK",
        "middle_name": "KYLE",
        "credential": "NP",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2013-08-05",
        "last_updated": "2022-02-09",
        "certification_date": "2022-02-09",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LF0000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Family",
            "state": "CA",
            "license": "95012148",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Thomas John Peitz, MD
• Judith Seeley Peletz, MFT
• Cristie Pellegrini, BS PHARMACY
• Robert Pellegrini
• Heidi Jeannette Pelot, MFT
• Peltz and Associates Physical Therapy Inc
• Aaron Peltz, D.P.T.
• Lawrence Peltz
• Van Arthur Pena, PH.D., M.D.
• Albert Peng, M.D.

• Family Nurse Practitioner in Santa Rosa, CA
• Providers in Santa Rosa, CA by specialty
• Family Nurse Practitioner in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 9, 2022; 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.