Derek Carl Bronson

Primary specialty

Physician AssistantTaxonomy code 363A00000X

Practice address

1717 Arlington Ave
Caldwell, ID 83605-4802

Phone

(208) 459-4641

NPI assigned

Jun 18, 2017

Last updated

Dec 28, 2021By the provider in NPPES

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

Electronic endpoints 1

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

Physician Assistant

Education

Other, 2019

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

Sacramento Ear Nose and Throat Surgical and Medical Group IncGroup PAC ID 6204905342, 29 clinicians

Vituity - Urgent Care Services PCGroup PAC ID 8022433085, 8 clinicians

Eric L Ellis MD IncGroup PAC ID 9032458815, 17 clinicians

Practice addresses (Care Compare)

Hospital & facility affiliations

• Sutter Roseville Medical Center Hospital, Roseville, CA, CCN 050309
• Sutter Auburn Faith Hospital Hospital, Auburn, CA, CCN 050498

Medicare enrollment (NPD)

Enrolled

Credentials

Physician Assistant

State licenses

Practice roles

Locations

Interoperability endpoints

• Direct secure messaging: derek.bronson.1@11381.direct.athenahealth.com
• Direct secure messaging: derek.bronson.1@19336.direct.athenahealth.com
• Direct secure messaging: derek.bronson.1@20515.direct.athenahealth.com

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

• Vituity - Urgent Care Services PC

  dba Jovive Urgent Care

  • Urgent Care Clinic/Center
  • Cameron Park, CA
  • NPI 1013588250
  Medicare reassignment Care Compare group NPD
• Eric L Ellis MD Inc

  dba Lincoln Urgent Care

  • Urgent Care Clinic/Center
  • Lincoln, CA
  • NPI 1386118305
  Medicare reassignment Care Compare group
• Permanente Medical Group Inc

  • Internal Medicine Physician
  • Santa Clara, CA
  • NPI 1073606299
  Medicare reassignment
• Sacramento Ear Nose & Throat Surgical & Medical Group Inc

  dba Sacramento Ear, Nose, & Throat

  • Otolaryngology Physician
  • Sacramento, CA
  • NPI 1497758155
  Care Compare group
• Permanente Medical Group, Inc

  • Clinical Medical Laboratory
  • San Jose, CA
  • NPI 1497971584
  NPD
• Sutter North Medical Foundation

  dba Sutter North Surgery Center

  • Ambulatory Surgical Clinic/Center
  • Yuba City, CA
  • NPI 1144251521
  NPD (past)

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

• Sutter Valley Hospitals

  dba Sutter Auburn Faith Hospital

  • General Acute Care Hospital
  • Auburn, CA
  • NPI 1194774299
  Care Compare affiliation
• Sutter Valley Hospitals

  dba Sutter Roseville Medical Center

  • General Acute Care Hospital
  • Roseville, CA
  • NPI 1356390264
  Care Compare affiliation
• Sutter Valley Hospitals

  • Home Health Agency
  • Auburn, CA
  • NPI 1417987751

  Hospital

  Care Compare affiliation

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

{
    "created_epoch": "1497744000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1640649600000",
    "number": "1962932343",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1800 HARRISON ST",
            "address_2": "FL 7",
            "city": "OAKLAND",
            "state": "CA",
            "postal_code": "946123466",
            "telephone_number": "505-620-0500"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1717 ARLINGTON AVE",
            "city": "CALDWELL",
            "state": "ID",
            "postal_code": "836054802",
            "telephone_number": "208-459-4641"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "BRONSON",
        "first_name": "DEREK",
        "middle_name": "CARL",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2017-06-18",
        "last_updated": "2021-12-28",
        "certification_date": "2021-08-26",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [
        {
            "endpointType": "SOAP",
            "endpointTypeDescription": "SOAP URL",
            "endpoint": "https://careepicwest.kp.org:14430/Interconnect-prodcalgateway/wcf/epic.community.hie/xcpdrespondinggatewaysync.svc/ncalceq",
            "affiliation": "Y",
            "endpointDescription": "Carequality",
            "affiliationName": "The Permanente Medical Group",
            "use": "HIE",
            "useDescription": "Health Information Exchange (HIE)",
            "contentType": "OTHER",
            "contentTypeDescription": "Other",
            "contentOtherDescription": "C-CDA",
            "address_1": "3600 Broadway",
            "city": "Oakland",
            "state": "CA",
            "country_code": "US",
            "postal_code": "946115730",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

• Trinidad Bridge, LPN
• Alexandria Blake Briggs, LMSW
• Jared Britton
• Anne Brock, RDN, LD
• Jason Eric Bromley
• Kayla Brooking, DO
• Diane Marie Brown, L.C.S.W.
• Matthew S Brown, MD
• Sherri L Brown, MD
• Gavin Bruderer, CRNA, MSNA

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

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 28, 2021; 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.