Individual provider Active NPI

Derek Samuel Weaver, DO

  • Family Medicine Physician
  • Sunnyside, WA
National Provider Identifier
1962660704
Registry record updated Apr 15, 2026
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Medicine PhysicianTaxonomy code 207Q00000X
License
OP60139736 Issued in WA
Practice address
2935 Allen Rd
Sunnyside, WA 98944-8931
Phone
(509) 837-0070
Fax
(509) 837-0690
NPI assigned
May 29, 2008
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Apr 15, 2026

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 OP60139736 WA Primary

Addresses

Primary practice location

2935 Allen Rd
Sunnyside, WA 98944-8931

Mailing address

2935 Allen Rd
Sunnyside, WA 98944-8931
Phone (509) 837-0070

Other identifiers 1

IdentifierTypeStateIssuer
1962660704MedicaidWA

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20150617000232 WA Practitioner - Family Practice 8325220098 Reassigns benefits to 2 organizations

Care Compare profile

Medicare Care Compare
Specialty
Family Practice
Education
Michigan State University College of Osteopathic Medicine, 2007
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Derek S Weaver DO PLLCGroup PAC ID 8123322716, 7 clinicians

Practice addresses (Care Compare)

2935 Allen Rd
Sunnyside, WA 98944-8931
Phone (509) 837-0070

Hospital & facility affiliations

Merit-based Incentive Payment System (MIPS)

Final score
83.73 of 100Reported as group
Quality
80.23
Promoting interoperability
82
Improvement activities
40

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
OP60139736WAMDFamily Medicine Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Prosser Public Hospital District of Benton County CurrentSince May 1, 2015 Accepting new patients
Derek S Weaver DO PLLC Family Medicine CurrentSince Apr 20, 2015 Accepting new patients
Prosser Public Hospital District of Benton County CurrentSince May 1, 2015 Accepting new patients

Locations

1105 Dale Ave
Benton City, WA 99320
Phone (509) 588-4075

2935 Allen Rd
Sunnyside, WA 98944
Phone (509) 837-0070

Interoperability endpoints

  • Direct secure messaging: derek.weaver.1@11508.direct.athenahealth.com

Ownership & related parties

All facility ownership & control disclosures 1

Facilities whose Medicare enrollment lists this provider’s PECOS associate ID as an owner or managing party.

FacilityTypeRoleSince
Weaver Family MedicineSunnyside, WA, CCN 503923 Rural health clinic 5% Or Greater Direct Ownership Interest (100%)
Corporate Officer (100%)
W-2 Managing Employee (100%)
Operational/Managerial Control (100%)
Apr 20, 2015
Apr 20, 2015
Apr 20, 2015
Apr 20, 2015

Owned or controlled facilities with NPI records 1

Facilities whose Medicare enrollment lists this provider as an owner, officer, director or managing party.

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.

Hospital & facility affiliations 1

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": "1212019200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1776211200000",
    "number": "1962660704",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2935 ALLEN RD",
            "city": "SUNNYSIDE",
            "state": "WA",
            "postal_code": "989448931",
            "telephone_number": "509-837-0070",
            "fax_number": "509-837-0690"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2935 ALLEN RD",
            "city": "SUNNYSIDE",
            "state": "WA",
            "postal_code": "989448931",
            "telephone_number": "509-837-0070",
            "fax_number": "509-837-0690"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "WEAVER",
        "first_name": "DEREK",
        "middle_name": "SAMUEL",
        "name_prefix": "Dr.",
        "credential": "DO",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2008-05-29",
        "last_updated": "2026-04-15",
        "certification_date": "2026-04-15",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "WA",
            "license": "OP60139736",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1962660704",
            "state": "WA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Sunnyside, WA

Sources for this page

Verify at the official NPI Registry.