Derrick Ray Jorgensen

Primary specialty

Physician AssistantTaxonomy code 363A00000X

License

PA-2250 Issued in ID

Practice address

3200 Channing Way Ste A206
Idaho Falls, ID 83404-7586

Phone

(208) 529-2230

Fax

(208) 561-8061

NPI assigned

Apr 14, 2022

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 ID

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

Physician Assistant

Education

Other, 2021

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

Steele Lake Specialty PLLCGroup PAC ID 1153774567, 20 clinicians

Practice addresses (Care Compare)

Hospital & facility affiliations

• Eastern Idaho Regional Medical Center Hospital, Idaho Falls, ID, CCN 130018

Medicare enrollment (NPD)

Enrolled

Credentials

Physician Assistant

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.

• Steele Lake Specialty PLLC

  • Surgery Physician
  • Idaho Falls, ID
  • NPI 1215716998
  Medicare reassignment Care Compare group
• Sterling Provider Group

  • Urgent Care Clinic/Center
  • Idaho Falls, ID
  • NPI 1205300407
  Medicare reassignment NPD
• Urgent Care Associates PLLC

  • Preferred Provider Organization
  • Idaho Falls, ID
  • NPI 1609046408
  NPD
• Sterling Provider Group

  • Urgent Care Clinic/Center
  • Butte, MT
  • NPI 1871220038
  NPD
• Idaho Physician Services Inc.

  dba East Falls Orthopedics

  • Orthopaedic Surgery Physician
  • Idaho Falls, ID
  • NPI 1902841893
  NPD (past)

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

• Eastern Idaho Health Services Inc

  dba Eastern Idaho Regional Medical Center

  • General Acute Care Hospital
  • Idaho Falls, ID
  • NPI 1225082209
  Care Compare affiliation

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

{
    "created_epoch": "1649894400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1780963200000",
    "number": "1609519198",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3200 CHANNING WAY STE A206",
            "city": "IDAHO FALLS",
            "state": "ID",
            "postal_code": "834047586",
            "telephone_number": "208-529-2230"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3200 CHANNING WAY STE A206",
            "city": "IDAHO FALLS",
            "state": "ID",
            "postal_code": "834047586",
            "telephone_number": "208-529-2230",
            "fax_number": "208-561-8061"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "JORGENSEN",
        "first_name": "DERRICK",
        "middle_name": "RAY",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2022-04-14",
        "last_updated": "2026-06-09",
        "certification_date": "2026-06-09",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "ID",
            "license": "PA-2250",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Nathan Jones, OD
• Rebecca Ann Jones
• Susan Kay Jones, LCSW28190
• William Jones, R.T., C.P.F.T.
• Jordan E. Higham PA (Just 4 kiDDS Dentistry For Children)
• Melinda L Jorgensen, PHD
• Joshua D Smith and Associates Inc
• Joshua D Smith and Associates Inc
• Joshua D Smith and Associates Inc
• Joshua D Smith and Associates Inc

• Physician Assistant in Idaho Falls, ID
• Providers in Idaho Falls, ID by specialty
• Physician Assistant in Idaho

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 9, 2026; 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.